Provider Demographics
NPI:1114021631
Name:HEALEY UROLOGY CLINIC, P.A.
Entity Type:Organization
Organization Name:HEALEY UROLOGY CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:HEALEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-729-6231
Mailing Address - Street 1:3180 CENTRAL MALL DR
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-8039
Mailing Address - Country:US
Mailing Address - Phone:409-729-6231
Mailing Address - Fax:409-727-6537
Practice Address - Street 1:3180 CENTRAL MALL DR
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8039
Practice Address - Country:US
Practice Address - Phone:409-729-6231
Practice Address - Fax:409-727-6537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00GT45Medicare ID - Type Unspecified