Provider Demographics
NPI:1346481611
Name:MEDSURGE ALLIANCE, PA
Entity Type:Organization
Organization Name:MEDSURGE ALLIANCE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DMITRY
Authorized Official - Middle Name:V
Authorized Official - Last Name:BUYANOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-616-9400
Mailing Address - Street 1:2425 BABCOCK RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4898
Mailing Address - Country:US
Mailing Address - Phone:210-616-9400
Mailing Address - Fax:210-616-9402
Practice Address - Street 1:2425 BABCOCK RD
Practice Address - Street 2:SUITE 108
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4898
Practice Address - Country:US
Practice Address - Phone:210-616-9400
Practice Address - Fax:210-616-9402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7996207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty