Provider Demographics
NPI:1780969097
Name:INNOVATIVE PHYSICIANS
Entity type:Organization
Organization Name:INNOVATIVE PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:DOUGLASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-328-8880
Mailing Address - Street 1:5656 BEE CAVE RD
Mailing Address - Street 2:E-200
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5280
Mailing Address - Country:US
Mailing Address - Phone:512-328-8880
Mailing Address - Fax:512-328-8933
Practice Address - Street 1:5656 BEE CAVE RD
Practice Address - Street 2:E-200
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5280
Practice Address - Country:US
Practice Address - Phone:512-328-8880
Practice Address - Fax:512-328-8933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty