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DERRICK WANSOM MD NPI 1306124912


NPI Information

NPI: 1306124912
Provider Name: DERRICK WANSOM, MD
Classification: Pain Medicine - 208VP0014X
Entity Type: Individual

Specialization: Interventional Pain Medicine

Organization: CENTRAL TEXAS PAIN INSTITUTE PLLC

PECOS Registration: Yes

Address:
4100 DUVAL RD
BLDG 3 STE 200
AUSTIN, TX
ZIP 78759
Phone: (512) 485-7200
Get Directions

Derrick Wansom, MD is an interventional pain medicine pain medicine in Austin, TX with 13 years of experience. The provider is interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. Derrick Wansom, MD NPI is 1306124912. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE
Graduation Year:2011

The provider's business location address is:

4100 DUVAL RD
BLDG 3 STE 200
AUSTIN, TX
ZIP 78759-275
Phone: (512) 485-7200
Fax: (512) 485-7224

The NPI 1306124912 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/31/2011 and was last updated on 5/29/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208VP0014XPain MedicineInterventional Pain MedicineQ9077TEXASYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.