Provider Demographics
NPI:1679291009
Name:CTRA PLLC
Entity type:Organization
Organization Name:CTRA PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONTY
Authorized Official - Middle Name:B
Authorized Official - Last Name:TEW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-518-4992
Mailing Address - Street 1:4701 BEE CAVES RD STE 201
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5366
Mailing Address - Country:US
Mailing Address - Phone:512-518-4992
Mailing Address - Fax:512-518-4993
Practice Address - Street 1:4701 BEE CAVES RD STE 201
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5366
Practice Address - Country:US
Practice Address - Phone:512-518-4992
Practice Address - Fax:512-518-4993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty