Basic Information
| Provider Information | |||||||||
| NPI: | 1447232467 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DALRYMPLE | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1313 RED RIVER ST | ||||||||
| Address2: | SUITE A1 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787011943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123247246 | ||||||||
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| Practice Location | |||||||||
| Address1: | 911 W 38TH ST | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123248670 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2005 | ||||||||
| LastUpdateDate: | 03/18/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0201X | K0704 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
ID Information
| ID | Type | State | Issuer | Description | 041389005 | 05 | TX | MEDICAID |