Provider Demographics
NPI:1679026488
Name:DOCTOR'S CLINIC OF RIO GRANDE CITY PLLC
Entity Type:Organization
Organization Name:DOCTOR'S CLINIC OF RIO GRANDE CITY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUREL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-560-8646
Mailing Address - Street 1:208 N BRITTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-3843
Mailing Address - Country:US
Mailing Address - Phone:210-560-8646
Mailing Address - Fax:
Practice Address - Street 1:208 N BRITTON AVE
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-3843
Practice Address - Country:US
Practice Address - Phone:210-560-8646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1378207R00000X
TXN9209208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty