Provider Demographics
NPI:1982664447
Name:FEASEL, ADRIENNE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:MARIE
Last Name:FEASEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11671 JOLLYVILLE RD
Mailing Address - Street 2:#104
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-3933
Mailing Address - Country:US
Mailing Address - Phone:512-345-3599
Mailing Address - Fax:512-345-3928
Practice Address - Street 1:11671 JOLLYVILLE RD
Practice Address - Street 2:#104
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-3933
Practice Address - Country:US
Practice Address - Phone:512-345-3599
Practice Address - Fax:512-345-3928
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL2883207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH52480Medicare UPIN
TX8D8002Medicare ID - Type Unspecified