Provider Demographics
NPI:1124290416
Name:SRYGLEY, FLETCHER DOUGLAS IV (MD)
Entity type:Individual
Prefix:
First Name:FLETCHER
Middle Name:DOUGLAS
Last Name:SRYGLEY
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10597
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78766-1597
Mailing Address - Country:US
Mailing Address - Phone:512-448-4588
Mailing Address - Fax:512-445-4511
Practice Address - Street 1:4310 JAMES CASEY ST
Practice Address - Street 2:STE. 4A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1251
Practice Address - Country:US
Practice Address - Phone:512-448-4588
Practice Address - Fax:512-445-4511
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2791207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8DF282OtherBCBS INDIVIDUAL #