Provider Demographics
NPI:1790862316
Name:ELENA GUROVA, MD PA
Entity Type:Organization
Organization Name:ELENA GUROVA, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND SECRETALY
Authorized Official - Prefix:DR
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUROVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-645-5915
Mailing Address - Street 1:PO BOX 770
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-0770
Mailing Address - Country:US
Mailing Address - Phone:817-645-5915
Mailing Address - Fax:817-645-5935
Practice Address - Street 1:519 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-3845
Practice Address - Country:US
Practice Address - Phone:817-645-5915
Practice Address - Fax:817-645-5935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7404207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183757701Medicaid
TX00W998Medicare PIN