Provider Demographics
NPI:1144950486
Name:FULL SPECTRUM WOUND CARE ALLIANCE
Entity type:Organization
Organization Name:FULL SPECTRUM WOUND CARE ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:DOYLE
Authorized Official - Last Name:DRURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-662-4800
Mailing Address - Street 1:11614 BEE CAVES RD STE 130
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-5551
Mailing Address - Country:US
Mailing Address - Phone:512-662-4800
Mailing Address - Fax:
Practice Address - Street 1:11614 BEE CAVES RD STE 130
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-5551
Practice Address - Country:US
Practice Address - Phone:512-662-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-10
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty