Provider Demographics
NPI:1578053591
Name:CORPUS CHRISTI UROLOGY GROUP, PLLC
Entity Type:Organization
Organization Name:CORPUS CHRISTI UROLOGY GROUP, PLLC
Other - Org Name:CCUG PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:NAISMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-884-6381
Mailing Address - Street 1:601 TEXAN TRL STE 100A
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-2548
Mailing Address - Country:US
Mailing Address - Phone:361-561-4140
Mailing Address - Fax:361-561-4141
Practice Address - Street 1:601 TEXAN TRL STE 100A
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-2548
Practice Address - Country:US
Practice Address - Phone:361-561-4140
Practice Address - Fax:361-561-4141
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORPUS CHRISTI UROLOGY GROUP, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy