Provider Demographics
NPI:1093940199
Name:SOUTH, ERIC (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:SOUTH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 UNIVERSITY DR E STE 245
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-3483
Mailing Address - Country:US
Mailing Address - Phone:979-721-9821
Mailing Address - Fax:979-721-9820
Practice Address - Street 1:3201 UNIVERSITY DR E STE 245
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3483
Practice Address - Country:US
Practice Address - Phone:979-721-9821
Practice Address - Fax:979-721-9820
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2023-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8150207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX302872201Medicaid
TX302872201Medicaid