Provider Demographics
NPI:1790296812
Name:MIDLAND GASTROENTEROLOGY AND HEPATOLOGY, P.A.
Entity Type:Organization
Organization Name:MIDLAND GASTROENTEROLOGY AND HEPATOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRATYUSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARAVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-262-1948
Mailing Address - Street 1:3305 ANDREWS HWY STE B1
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-5130
Mailing Address - Country:US
Mailing Address - Phone:432-262-1948
Mailing Address - Fax:
Practice Address - Street 1:3305 ANDREWS HWY # B1
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-5130
Practice Address - Country:US
Practice Address - Phone:432-262-3880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR3933207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty