Provider Demographics
NPI:1598935165
Name:ROUND ROCK MEDICAL AESTHETICS AND URGENT CARE PLLC
Entity Type:Organization
Organization Name:ROUND ROCK MEDICAL AESTHETICS AND URGENT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BRODER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-246-2639
Mailing Address - Street 1:2400 IH 35 S
Mailing Address - Street 2:SUITE 135
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-7912
Mailing Address - Country:US
Mailing Address - Phone:512-246-2639
Mailing Address - Fax:512-246-7414
Practice Address - Street 1:2400 IH 35 S
Practice Address - Street 2:SUITE 135
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-7912
Practice Address - Country:US
Practice Address - Phone:512-246-2639
Practice Address - Fax:512-246-7414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2154207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty