Provider Demographics
NPI:1194853242
Name:SAN MARCOS OBSTETRICS AND GYNECOLOGY, PLLC
Entity Type:Organization
Organization Name:SAN MARCOS OBSTETRICS AND GYNECOLOGY, PLLC
Other - Org Name:KOTESWARA R KUNDA, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KOTESWARA
Authorized Official - Middle Name:RAO
Authorized Official - Last Name:KUNDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-396-3545
Mailing Address - Street 1:2001 MEDICAL PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7580
Mailing Address - Country:US
Mailing Address - Phone:512-396-3545
Mailing Address - Fax:512-396-1349
Practice Address - Street 1:2001 MEDICAL PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7580
Practice Address - Country:US
Practice Address - Phone:512-396-3545
Practice Address - Fax:512-396-1349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3367207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00518TMedicare ID - Type Unspecified