Provider Demographics
NPI:1205376068
Name:ER DOCS PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:ER DOCS PROFESSIONAL ASSOCIATION
Other - Org Name:COSMETIC CENTER LAREDO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:SERGIO
Authorized Official - Last Name:CANTU-WILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-724-6000
Mailing Address - Street 1:6410 MCPHERSON RD STE 3
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6193
Mailing Address - Country:US
Mailing Address - Phone:956-724-6000
Mailing Address - Fax:956-724-6000
Practice Address - Street 1:6410 MCPHERSON RD STE 3
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6193
Practice Address - Country:US
Practice Address - Phone:956-724-6000
Practice Address - Fax:956-724-6000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2997261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical