DERRICK WANSOM


Address: 4100 Duval Rd, Bldg 3 Ste 200, Austin, TX 78759-4275
Phone: 5124857200

DERRICK WANSOM (NPI# 1306124912) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1306124912
Entity Type Individual
Full Name DERRICK WANSOM
Credential MD
Practice Address 4100 Duval Rd
Bldg 3 Ste 200
Austin
TX 78759-4275
Mailing Address Po Box 733946
Dallas
TX 75373-3946
Practice Telephone 5124857200
Practice Fax Number 5124857224
Mailing Telephone 5124857200
Mailing Fax Number 5124857224
Enumeration Date 2011-07-31
Last Update Date 2019-05-29
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 208VP0014X Pain Medicine
Specialization: Interventional Pain Medicine
Q9077 TX Allopathic & Osteopathic Physicians

Office Location

Street Address 4100 DUVAL RD
BLDG 3 STE 200
City AUSTIN
State TX
Zip Code 78759-4275

Providers in the same location

NPI Name Taxonomy Address Enumeration
1811960693 Michelle A Berger Ophthalmology 4100 Duval Rd, Bldg 4 Ste 205, Austin, TX 78759 2006-02-10
1730730979 Monarch Medical Management Group, LLC Contractor 4100 Duval Rd, Bldg 3, Suite 100, Austin, TX 78759-3550 2019-09-27
1336799667 Christopher Michael Petiprin Contractor 4100 Duval Rd, Building 3, Suite 100, Austin, TX 78759-3550 2019-09-18
1417422676 Jessica Lynn Laskoskie Nurse Practitioner 4100 Duval Rd, Bldg. IIi Suite 200, Austin, TX 78759 2018-10-03
1366959892 Aabc In Your Home LLC Midwife 4100 Duval Rd, Bldg 2 #101, Austin, TX 78759 2018-01-05
1265943765 Rebekah Lynne Randall Registered Nurse 4100 Duval Rd, Austin, TX 78759-3456 2017-10-24
1316478951 Anne Leclercq Midwife 4100 Duval Rd, Austin, TX 78759-3550 2017-03-24
1437696184 Kimberly Muck Nurse Practitioner 4100 Duval Rd, Bldg IIi Ste 200, Austin, TX 78759 2017-01-19
1073985446 Nicole Antoinette Busch Clinical Nurse Specialist 4100 Duval Rd, Bldg IIi Suite 200, Austin, TX 78759 2015-10-26
1942606587 Pain Specialists of Austin Pharmacy Pharmacy 4100 Duval Rd, Building 3 Suite 201, Austin, TX 78759-3550 2014-11-10
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1629677612 Laurel Sunde Nurse Practitioner 11111 Research Blvd-ll2, Austin, TX 78759 2020-10-20
1558990242 Sarah Ann Weier Counselor 8500 North Mopac Expressway, Austin, TX 78759 2020-04-03
1124672696 Gabrielle Jade Hurley Physical Therapist 9333 Research Blvd Ste 400, Austin, TX 78759 2019-08-01
1730740671 Jennifer Kraft Behavior Technician 9600 Great Hills Trail, Suite 150w, Austin, TX 78759 2019-06-21
1881199024 Pediatric Home Healthcare, LLC Home Health 8501 N Mopac Expy Ste 410, Austin, TX 78759 2018-03-29
1679072870 Sylvia Chen Psychologist 8400 N Mopac Expy Ste 302, Austin, TX 78759 2018-02-03
1215443064 Greater Austin Urology, Pllc Urology 11673 Jollyville Rd Ste B101, Austin, TX 78759 2017-12-15
1831603042 Jane A Dykes Counselor 9015 Mountain Ridge Dr., Houston Bldg., Ste. 200, Austin, TX 78759 2017-11-27
1134632706 Gary Victor Friedman Pharmacist 4411 Spicewood Springs Road #1111, Austin, TN 78759 2017-11-06
1740720242 Taylor Renee Cahill Behavioral Analyst 9901 North Capital of Texas Hwy, Austin, TX 78759 2017-03-02
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Taxonomy Information

Taxonomy Code 208VP0014X
Grouping Allopathic & Osteopathic Physicians
Classification Pain Medicine
Specialization Interventional Pain Medicine

Taxonomy Definition

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.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1013472265 Premiere Pain Specialists LLC Pain Medicine 12309 N Mopac Expy Ste 125, Austin, TX 78758-2577 2019-02-01
1871970871 Gregory Nicholas Yanez Pain Medicine 4316 James Casey St Building B Suite 200, Austin, TX 78745 2015-04-29
1578567459 Integrative Pain Services Pa Pain Medicine 4807 Spicewood Springs Rd, Ste 1235, Austin, TX 78759-8478 2005-06-09
1487196614 Alan D Silberberg, Md Pa Pain Medicine 5625 Eiger Rd, Suite 160, Austin, TX 78735-8977 2016-11-04
1235514704 Central Texas Pain Center North, Pllc Pain Medicine 4316 James Casey St, Bldg B, Suite 200, Austin, TX 78745-1116 2015-07-27
1821484031 Jamal Hasoon Pain Medicine 4316 James Casey St Ste 200, Austin, TX 78745-1116 2015-04-14
1295130912 Central Texas Pain Center, Pllc Pain Medicine 4316 James Casey St, Bldg B, Suite 200, Austin, TX 78745-1116 2014-10-23
1184987174 Rahul Sarna Pain Medicine 4100 Duval Rd, Bldg IIi Ste 200, Austin, TX 78759 2012-06-25
1336416510 Robert P Wills Md Pllc Pain Medicine 2200 Park Bend Dr, Bldg 1, Suite 201, Austin, TX 78758-5387 2011-11-16
1053526343 Pain Management Consultants, Pa Pain Medicine 101 W Koenig Ln, Ste 100, Austin, TX 78751-1213 2007-05-11
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Competitor

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City AUSTIN
Zip Code 78759

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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