Provider Demographics
NPI:1700186996
Name:GERIATRIC PHYSICIANS CARE, P.A.
Entity Type:Organization
Organization Name:GERIATRIC PHYSICIANS CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FOWLER-GULDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-440-9336
Mailing Address - Street 1:2 N FLAMINGO ST
Mailing Address - Street 2:
Mailing Address - City:LA MARQUE
Mailing Address - State:TX
Mailing Address - Zip Code:77568-6528
Mailing Address - Country:US
Mailing Address - Phone:409-440-9336
Mailing Address - Fax:713-588-8410
Practice Address - Street 1:2 N FLAMINGO ST
Practice Address - Street 2:
Practice Address - City:LA MARQUE
Practice Address - State:TX
Practice Address - Zip Code:77568-6528
Practice Address - Country:US
Practice Address - Phone:409-440-9336
Practice Address - Fax:713-588-8410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1438208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty