Provider Demographics
NPI:1346353240
Name:SOUTHEAST TEXAS UROLOGY ASSOCIATES, LLP
Entity Type:Organization
Organization Name:SOUTHEAST TEXAS UROLOGY ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:DENTON
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:409-899-4111
Mailing Address - Street 1:755 N 11TH ST
Mailing Address - Street 2:SUITE P3200
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1501
Mailing Address - Country:US
Mailing Address - Phone:409-899-4111
Mailing Address - Fax:409-899-5670
Practice Address - Street 1:755 N 11TH ST
Practice Address - Street 2:SUITE P3200
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1501
Practice Address - Country:US
Practice Address - Phone:409-899-4111
Practice Address - Fax:409-899-5670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00880NOtherMEDICARE 2ND NUMBER
TX109365002Medicaid
TXCG1207OtherGROUP RAILROAD MEDICARE
TX109365001Medicaid
TX109365002Medicaid