Provider Demographics
NPI:1205839594
Name:SOUTHWEST ENDOCRINE CONSULTANTS
Entity Type:Organization
Organization Name:SOUTHWEST ENDOCRINE CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDOCRINOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:WILBUR
Authorized Official - Middle Name:J
Authorized Official - Last Name:STRADER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-533-5486
Mailing Address - Street 1:1201 E SCHUSTER AVE
Mailing Address - Street 2:BLDG 7
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4660
Mailing Address - Country:US
Mailing Address - Phone:915-533-5486
Mailing Address - Fax:915-533-9602
Practice Address - Street 1:1201 E SCHUSTER AVE
Practice Address - Street 2:BLDG 7
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4660
Practice Address - Country:US
Practice Address - Phone:915-533-5486
Practice Address - Fax:915-533-9602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1353OtherMEDICARE RAILROAD
TXZ00BA817Medicaid
TXZ00BA817Medicaid