Provider Demographics
NPI:1942331335
Name:SOUTH TEXAS GASTROENTEROLOGY ASSOCIATES PA
Entity type:Organization
Organization Name:SOUTH TEXAS GASTROENTEROLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUBRAHMANYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BEHARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-618-7080
Mailing Address - Street 1:P. O. BOX 1661
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78296-1661
Mailing Address - Country:US
Mailing Address - Phone:956-682-4800
Mailing Address - Fax:
Practice Address - Street 1:5525 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-5563
Practice Address - Country:US
Practice Address - Phone:956-682-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00J43HOtherBCBS
TX083176001Medicaid
TXCD1727OtherRAILROAD
TX00J43HMedicare PIN