Provider Demographics
NPI:1679529143
Name:SOUTH TEXAS ENT CONSULTANTS PA
Entity type:Organization
Organization Name:SOUTH TEXAS ENT CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:NOORILY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-614-5600
Mailing Address - Street 1:7909 FREDERICKSBURG RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3403
Mailing Address - Country:US
Mailing Address - Phone:210-614-5600
Mailing Address - Fax:210-614-8963
Practice Address - Street 1:7909 FREDERICKSBURG RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3403
Practice Address - Country:US
Practice Address - Phone:210-614-5600
Practice Address - Fax:210-614-8963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094593301Medicaid
TX082974901Medicaid
TX082974901Medicaid