Provider Demographics
NPI:1114944840
Name:TEXAS GASTROINTESTINAL ASSOCIATES PA
Entity Type:Organization
Organization Name:TEXAS GASTROINTESTINAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:FAYEZ
Authorized Official - Middle Name:G
Authorized Official - Last Name:SELF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-681-2226
Mailing Address - Street 1:2694 N GALLOWAY AVE
Mailing Address - Street 2:STE 501
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150
Mailing Address - Country:US
Mailing Address - Phone:972-681-2226
Mailing Address - Fax:972-681-7838
Practice Address - Street 1:2694 N GALLOWAY AVE
Practice Address - Street 2:STE 501
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150
Practice Address - Country:US
Practice Address - Phone:972-681-2226
Practice Address - Fax:972-681-7838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109497101Medicaid
TX109497102Medicaid
TX109497101Medicaid