Provider Demographics
NPI:1811365802
Name:SOUTH TEXAS UROGYNECOLOGY PLLC
Entity Type:Organization
Organization Name:SOUTH TEXAS UROGYNECOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:D
Authorized Official - Last Name:TRESZEZAMSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-402-3700
Mailing Address - Street 1:540 MADISON OAK DR
Mailing Address - Street 2:SUITE 570
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3943
Mailing Address - Country:US
Mailing Address - Phone:210-402-3700
Mailing Address - Fax:210-402-3892
Practice Address - Street 1:540 MADISON OAK DR
Practice Address - Street 2:SUITE 570
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3943
Practice Address - Country:US
Practice Address - Phone:210-402-3700
Practice Address - Fax:210-402-3892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPO145207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX296661601Medicaid
TXTXB152643Medicare PIN