Provider Demographics
NPI:1801166020
Name:NEUROAUSTIN NEUROLOGY ASSOCIATES, PLLC
Entity type:Organization
Organization Name:NEUROAUSTIN NEUROLOGY ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-433-6333
Mailing Address - Street 1:4544 S LAMAR BLVD STE 750
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1500
Mailing Address - Country:US
Mailing Address - Phone:512-433-6333
Mailing Address - Fax:512-433-6331
Practice Address - Street 1:4544 S LAMAR BLVD STE 750
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1500
Practice Address - Country:US
Practice Address - Phone:512-433-6333
Practice Address - Fax:512-433-6331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL55432084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G73968Medicare UPIN