Basic Information
| Provider Information | |||||||||
| NPI: | 1235338120 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHALSCHA | ||||||||
| FirstName: | ALAN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2115 KRAMER LN | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787584013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129789000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1210 W BRAKER LN | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787583801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129789300 | ||||||||
| FaxNumber: | 5122792556 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2007 | ||||||||
| LastUpdateDate: | 01/05/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R0494 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 4182 | AZ | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 294807 | 05 | AZ | MEDICAID |