Provider Demographics
NPI:1538107503
Name:SONGCO, GARY M (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:M
Last Name:SONGCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 LONGSFORD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1820
Mailing Address - Country:US
Mailing Address - Phone:210-226-5933
Mailing Address - Fax:
Practice Address - Street 1:61 LONGSFORD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1820
Practice Address - Country:US
Practice Address - Phone:210-226-5933
Practice Address - Fax:210-226-6433
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2183207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB110559Medicare UPIN
TXB26580Medicare UPIN
TX097514601Medicare ID - Type Unspecified