Provider Demographics
NPI:1780617571
Name:HAEUSSLEIN, ERNEST A (MD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:A
Last Name:HAEUSSLEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1400 N IH 35
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1926
Mailing Address - Country:US
Mailing Address - Phone:512-324-8300
Mailing Address - Fax:512-324-8301
Practice Address - Street 1:1301 W 38TH ST
Practice Address - Street 2:SUITE 514
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1000
Practice Address - Country:US
Practice Address - Phone:512-681-0500
Practice Address - Fax:512-681-0501
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP1317207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX294032202Medicaid
TX8DD094OtherBCBS
TX294032203Medicaid
TX294032204Medicaid
TX294032201Medicaid
TX8ET246OtherBCBS
TX294032201Medicaid
TX8DD094OtherBCBS
TXA52831Medicare UPIN
TX294032203Medicaid
TXTXB148556Medicare PIN