Provider Demographics
NPI:1609080639
Name:LAREDO MATERNITY AND GYNECOLOGY PA
Entity Type:Organization
Organization Name:LAREDO MATERNITY AND GYNECOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:956-795-8375
Mailing Address - Street 1:1710 E SAUNDERS ST STE 480
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5454
Mailing Address - Country:US
Mailing Address - Phone:956-795-8375
Mailing Address - Fax:956-795-8372
Practice Address - Street 1:1710 E SAUNDERS ST STE 480
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5454
Practice Address - Country:US
Practice Address - Phone:956-795-8375
Practice Address - Fax:956-795-8372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00514TMedicare ID - Type Unspecified