# AGELESS ABANDON

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992092951
- **Authorized official:** MRS. TRACY M. GANSKE (CEO)
- **Authorized official phone:** (512) 459-4400

## Contact information

- **Practice address:** 103 TAMARAC CT, LAKEWAY, TX 78734-4666
- **Practice address phone:** (512) 459-4400
- **Mailing address:** 1010 W 9TH ST, AUSTIN, TX 78703-4924
- **Mailing address phone:** (512) 459-4400

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | G5718 | TX | Yes |

## Other

- **Enumeration date:** 06/28/2011
- **Last updated:** 06/28/2011