Provider Demographics
NPI:1306033196
Name:TEXAS GULF CLINIC PA
Entity Type:Organization
Organization Name:TEXAS GULF CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:DE OLIVEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-292-0238
Mailing Address - Street 1:201 OAK DR S STE 203A
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5777
Mailing Address - Country:US
Mailing Address - Phone:979-292-0238
Mailing Address - Fax:979-292-0238
Practice Address - Street 1:201 OAK DR S STE 203A
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5777
Practice Address - Country:US
Practice Address - Phone:979-292-0238
Practice Address - Fax:979-292-0238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00143ZMedicare PIN