Provider Demographics
NPI:1467453860
Name:WEST TEXAS UROLOGY PA
Entity Type:Organization
Organization Name:WEST TEXAS UROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:STAUB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-687-0311
Mailing Address - Street 1:2706 W CUTHBERT BLDG C
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-3887
Mailing Address - Country:US
Mailing Address - Phone:432-687-0311
Mailing Address - Fax:432-687-0312
Practice Address - Street 1:2706 W CUTHBERT BLDG C
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-3887
Practice Address - Country:US
Practice Address - Phone:432-687-0311
Practice Address - Fax:432-687-0312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3422174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172553301Medicaid
TX45D0508718OtherCLIA
TX172553301Medicaid
TX45D0508718OtherCLIA