Provider Demographics
NPI:1124578612
Name:DIGESTIVE AND LIVER DISEASE CENTER OF SAN ANTONIO PLLC
Entity Type:Organization
Organization Name:DIGESTIVE AND LIVER DISEASE CENTER OF SAN ANTONIO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:M
Authorized Official - Last Name:NARVAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-650-9119
Mailing Address - Street 1:12602 TOEPPERWEIN RD STE 205
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3271
Mailing Address - Country:US
Mailing Address - Phone:210-650-9119
Mailing Address - Fax:210-650-9681
Practice Address - Street 1:12602 TOEPPERWEIN RD STE 205
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3271
Practice Address - Country:US
Practice Address - Phone:210-650-9119
Practice Address - Fax:210-650-9681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-07
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5014207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty