Jack Lee Walzel, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

G8490 Issued in TX

Practice address

3705 Medical Pkwy Ste 250
Austin, TX 78705-1022

Phone

(512) 302-1210

Fax

(512) 451-9752

NPI assigned

Jun 23, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southwest Bariatric Surgeons PLLC

  • Surgery Physician
  • Austin, TX
  • NPI 1700836756
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612310400000",
    "number": "1093711012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3705 MEDICAL PKWY STE 250",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787051022",
            "telephone_number": "512-302-1210",
            "fax_number": "512-451-9752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3705 MEDICAL PKWY STE 250",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787051022",
            "telephone_number": "512-302-1210",
            "fax_number": "512-451-9752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALZEL",
        "first_name": "JACK",
        "middle_name": "LEE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-23",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "G8490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Baird Walton, PA-C
• Kallyopi Vafiadis Walton, APRN, CPNP-AC
• Mitchell Thomas Walton, MD
• Laura Sue Waltrip, MD
• Stephanie Lynn Walts-Osma, M.A., L.P.C.
• Nicole Hoyun Wan, DC
• Wanda E Price (Goingslimmer)
• Gabriel D. Wander, CRNA
• Cheryl E. Wanek, P.T.
• Andrew Wang, D.O.

• Surgery Physician in Austin, TX
• Providers in Austin, TX by specialty
• Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.