Provider Demographics
NPI:1235286857
Name:SOUTH TEXAS DIABETES AND ENDOCRINE CLINIC, P.A.
Entity Type:Organization
Organization Name:SOUTH TEXAS DIABETES AND ENDOCRINE CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:P
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-928-1909
Mailing Address - Street 1:2101 S CYNTHIA ST STE D1
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1340
Mailing Address - Country:US
Mailing Address - Phone:956-928-1909
Mailing Address - Fax:
Practice Address - Street 1:2101 S CYNTHIA ST STE D1
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1340
Practice Address - Country:US
Practice Address - Phone:956-928-1909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2011-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143648701Medicaid
TX00440RMedicare PIN
TX143648701Medicaid