Provider Demographics
NPI:1659135200
Name:ESPADA PHYSICIANS GROUP PLLC
Entity Type:Organization
Organization Name:ESPADA PHYSICIANS GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:TELLEZ FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-500-3008
Mailing Address - Street 1:27638 INTERSTATE 10 W
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006
Mailing Address - Country:US
Mailing Address - Phone:979-500-3008
Mailing Address - Fax:979-481-5120
Practice Address - Street 1:27638 INTERSTATE 10 W
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006
Practice Address - Country:US
Practice Address - Phone:979-500-3008
Practice Address - Fax:979-481-5120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty