Provider Demographics
NPI:1386039360
Name:MD GASTROENTEROLOGY ANESTHESIA SERVICES, PLLC
Entity Type:Organization
Organization Name:MD GASTROENTEROLOGY ANESTHESIA SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:RADHA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMERISA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-540-8997
Mailing Address - Street 1:16360 PARK TEN PL STE 310
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-5049
Mailing Address - Country:US
Mailing Address - Phone:979-549-1131
Mailing Address - Fax:
Practice Address - Street 1:16360 PARK TEN PL STE 310
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-5049
Practice Address - Country:US
Practice Address - Phone:979-549-1131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7210207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty