Provider Demographics
NPI:1659535177
Name:EAST AUSTIN OBGYN
Entity Type:Organization
Organization Name:EAST AUSTIN OBGYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-784-2543
Mailing Address - Street 1:14900 AVERY RANCH BLVD
Mailing Address - Street 2:C200-54
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-3951
Mailing Address - Country:US
Mailing Address - Phone:512-784-2543
Mailing Address - Fax:
Practice Address - Street 1:14900 AVERY RANCH BLVD
Practice Address - Street 2:C200-54
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-3951
Practice Address - Country:US
Practice Address - Phone:512-784-2543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7522207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty