Provider Demographics
NPI:1295524106
Name:FDA MEDICAL PARTNERS PLLC
Entity type:Organization
Organization Name:FDA MEDICAL PARTNERS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ANNELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PETIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-668-4334
Mailing Address - Street 1:4316 JAMES CASEY ST STE 100
Mailing Address - Street 2:BUILDING F
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 E FM 1626 STE 104
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-6035
Practice Address - Country:US
Practice Address - Phone:512-989-6336
Practice Address - Fax:512-614-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0301XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBrain Injury MedicineGroup - Multi-Specialty