Provider Demographics
NPI:1598992513
Name:EASTSIDE DOCTORS' ASSOCIATION, LLC
Entity Type:Organization
Organization Name:EASTSIDE DOCTORS' ASSOCIATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KENYON
Authorized Official - Middle Name:
Authorized Official - Last Name:BEHRENS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:915-592-8223
Mailing Address - Street 1:7812 GATEWAY BLVD E
Mailing Address - Street 2:SUITE 230
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79915-1815
Mailing Address - Country:US
Mailing Address - Phone:915-592-8222
Mailing Address - Fax:915-592-8328
Practice Address - Street 1:7812 GATEWAY BLVD E
Practice Address - Street 2:SUITE 230
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-1815
Practice Address - Country:US
Practice Address - Phone:915-592-8222
Practice Address - Fax:915-592-8328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty