Provider Demographics
NPI:1043439144
Name:RADIOLOGY ASSOCIATION P.A.
Entity Type:Organization
Organization Name:RADIOLOGY ASSOCIATION P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:ALEJANDRO
Authorized Official - Last Name:PELAEZ ANTELO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-257-8484
Mailing Address - Street 1:PO BOX 291286
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78029-1286
Mailing Address - Country:US
Mailing Address - Phone:830-257-8484
Mailing Address - Fax:830-896-5211
Practice Address - Street 1:2 DAVENTRY LN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1239
Practice Address - Country:US
Practice Address - Phone:830-257-8484
Practice Address - Fax:830-896-5211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH11752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0644UOtherBLUE CROSS
TX177407702Medicaid
TX0644UOtherBLUE CROSS
TX177407702Medicaid