Basic Information
| Provider Information | |||||||||
| NPI: | 1558339663 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VAISMAN | ||||||||
| FirstName: | DAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 N IH 35 | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787011926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123248300 | ||||||||
| FaxNumber: | 5123248301 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 SETON PKWY | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | ROUND ROCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786658002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123244812 | ||||||||
| FaxNumber: | 5123244728 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 12/22/2014 | ||||||||
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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 | 207RC0000X | M0332 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 172467603 | 05 | TX | MEDICAID | 172467602 | 05 | TX | MEDICAID | 172467604 | 05 | TX | MEDICAID | 8CY383 | 01 | TX | BCBS | OTHER | 172467605 | 05 | TX | MEDICAID | 8ET723 | 01 | TX | BCBS | OTHER |