Provider Demographics
NPI:1861804965
Name:GREG MARCHAND FAMILY MEDICINE PA
Entity type:Organization
Organization Name:GREG MARCHAND FAMILY MEDICINE PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCHAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-394-6020
Mailing Address - Street 1:4534 W GATE BLVD
Mailing Address - Street 2:SUITE113
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1485
Mailing Address - Country:US
Mailing Address - Phone:512-394-6020
Mailing Address - Fax:512-350-2825
Practice Address - Street 1:4534 W GATE BLVD
Practice Address - Street 2:SUITE113
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1485
Practice Address - Country:US
Practice Address - Phone:512-394-6020
Practice Address - Fax:512-350-2825
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREG MARCHAND FAMILY MEDICINE PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-22
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8620207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8983B9OtherMEDICARE INDIVIDUAL
TXG8620OtherTEXAS MEDICAL LICENSE