Basic Information
Provider Information
NPI: 1790129161
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MORSTAD
FirstName: AMANDA
MiddleName: R
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7000 N MO PAC EXPY STE 420
Address2:  
City: AUSTIN
State: TX
PostalCode: 787313055
CountryCode: US
TelephoneNumber: 5124820045
FaxNumber: 5124769892
Practice Location
Address1: 12221 N MO PAC EXPY
Address2:  
City: AUSTIN
State: TX
PostalCode: 787582401
CountryCode: US
TelephoneNumber: 5129011000
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/29/2013
LastUpdateDate: 09/20/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XQ8540TXY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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