Provider Demographics
NPI:1265858492
Name:ANWAR S GERGES MD PLLC
Entity Type:Organization
Organization Name:ANWAR S GERGES MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-481-9544
Mailing Address - Street 1:19234 STONEHUE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3477
Mailing Address - Country:US
Mailing Address - Phone:210-481-9544
Mailing Address - Fax:210-481-9545
Practice Address - Street 1:19234 STONEHUE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3477
Practice Address - Country:US
Practice Address - Phone:210-481-9544
Practice Address - Fax:210-481-9545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5769207RN0300X
TXM8988207YX0905X
2086S0122X
TXK2111208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117880802Medicaid
TX117880802Medicaid