Provider Demographics
NPI:1902236003
Name:DR. AV, PLLC
Entity Type:Organization
Organization Name:DR. AV, PLLC
Other - Org Name:DR. AV, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTHCARE PROFESSIONAL
Authorized Official - Prefix:
Authorized Official - First Name:ALEKSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:VIDACIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-787-6621
Mailing Address - Street 1:PO BOX 684905
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78768-4905
Mailing Address - Country:US
Mailing Address - Phone:210-787-6621
Mailing Address - Fax:512-904-5603
Practice Address - Street 1:210 LEE BARTON DR
Practice Address - Street 2:UNIT # 206
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-1045
Practice Address - Country:US
Practice Address - Phone:210-787-6621
Practice Address - Fax:512-904-5603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-26
Last Update Date:2013-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4181207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty