Provider Demographics
NPI:1053642983
Name:SA EXPERT PHYSICIANS PLLC
Entity Type:Organization
Organization Name:SA EXPERT PHYSICIANS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-404-3024
Mailing Address - Street 1:25002 GENESSE VALEY DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-2703
Mailing Address - Country:US
Mailing Address - Phone:281-404-3024
Mailing Address - Fax:281-520-4221
Practice Address - Street 1:1010 NW LOOP 410
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2220
Practice Address - Country:US
Practice Address - Phone:281-404-3024
Practice Address - Fax:281-520-4221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty