Provider Demographics
NPI:1720044902
Name:SOUTHEAST TEXAS GASTROENTEROLOGY ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:SOUTHEAST TEXAS GASTROENTEROLOGY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:409-833-5858
Mailing Address - Street 1:950 N 14TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1101
Mailing Address - Country:US
Mailing Address - Phone:406-833-5858
Mailing Address - Fax:403-833-1155
Practice Address - Street 1:950 N 14TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1101
Practice Address - Country:US
Practice Address - Phone:406-833-5858
Practice Address - Fax:403-833-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00B94SOtherBCBS
TX00B94SMedicare PIN