Individual
GREG THAERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12221 N MOPAC EXPY, AUSTIN, TX 78758-2401
(512) 901-4011
(512) 901-3911
Mailing address
12221 N MOPAC EXPY, AUSTIN, TX 78758-2401
(512) 901-4011
(512) 901-3911
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
P5743
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
323968301
—
TX
01
—
P01330570
RRMC PTAN
TX
Enumeration date
05/03/2007
Last updated
01/25/2022
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