Provider Demographics
NPI:1306257738
Name:JARZOMBEK, ALLEN NICHOLAS (MD)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:NICHOLAS
Last Name:JARZOMBEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5625 EIGER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8982
Mailing Address - Country:US
Mailing Address - Phone:512-892-7076
Mailing Address - Fax:855-270-9668
Practice Address - Street 1:3101 HIGHWAY 71 E STE 101
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-5159
Practice Address - Country:US
Practice Address - Phone:512-304-0300
Practice Address - Fax:855-270-9668
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS3000207Q00000X, 207Q00000X
AL35152207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1306257738Medicaid