Provider Demographics
NPI:1467077883
Name:TEXAS GASTRODIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:TEXAS GASTRODIAGNOSTICS, LLC
Other - Org Name:TEXAS GASTRODIAGNOSTICS, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:GOROSPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-529-0020
Mailing Address - Street 1:11621 PELLICANO DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6242
Mailing Address - Country:US
Mailing Address - Phone:915-529-0020
Mailing Address - Fax:210-614-4636
Practice Address - Street 1:9555 DIANA DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-6951
Practice Address - Country:US
Practice Address - Phone:915-529-0020
Practice Address - Fax:915-600-2712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-11
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty