Provider Demographics
NPI:1053399477
Name:VIERNES, JAY L (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:L
Last Name:VIERNES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6210 E HIGHWAY 290
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1142
Mailing Address - Country:US
Mailing Address - Phone:512-483-9596
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:6811 AUSTIN CENTER BLVD STE 300
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3146
Practice Address - Country:US
Practice Address - Phone:512-346-8888
Practice Address - Fax:512-344-0365
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM3415207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000302315OtherHMSA
TX181242203Medicaid
TX181242202Medicaid
TX181242201Medicaid
TXP00378784Medicaid
TX8G4721Medicare PIN
TX181242203Medicaid
TX181242202Medicaid