Organization Name: | AGELESS ABANDON |
NPI Number: | 1992092951 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TRACY M. GANSKE (CEO) |
Mailing Address: | 103 Tamarac Ct Lakeway |
State: | TX US |
Postal Code: | 787344666 |
Phone Number: | 5124594400 |
Fax Number: | |
NPI Enumeration Date: | 06/28/2011 |
NPI Last Update Date: | 06/28/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207V00000X |
License Number: | G5718 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Obstetrics & Gynecology |
Taxonomy Specialization: | |
Taxonomy Definition: | An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |