Provider Demographics
NPI:1396861209
Name:CABANSAG, REMEDIOS R (MD)
Entity Type:Individual
Prefix:DR
First Name:REMEDIOS
Middle Name:R
Last Name:CABANSAG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11803 SO FREEWAX
Mailing Address - Street 2:SUITE 254
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76115
Mailing Address - Country:US
Mailing Address - Phone:817-551-2963
Mailing Address - Fax:817-568-1663
Practice Address - Street 1:11803 SO FREEWAX
Practice Address - Street 2:SUITE 254
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76115
Practice Address - Country:US
Practice Address - Phone:817-551-2963
Practice Address - Fax:817-568-1663
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9958207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000B14Y8Medicaid
TXP000B14Y8Medicaid