Provider Demographics
NPI:1679108195
Name:DUSTIN DWIGGINS MD PA
Entity type:Organization
Organization Name:DUSTIN DWIGGINS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DWIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-548-5373
Mailing Address - Street 1:1703 SANCHEZ ST APT 1
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-1642
Mailing Address - Country:US
Mailing Address - Phone:512-548-5373
Mailing Address - Fax:512-548-5374
Practice Address - Street 1:12701 W STATE HIGHWAY 29 STE 5
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-6348
Practice Address - Country:US
Practice Address - Phone:512-548-5373
Practice Address - Fax:512-548-5374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1487071742OtherNPI