Provider Demographics
NPI:1821328493
Name:ISIDRA VEVE M.D. PLLC
Entity Type:Organization
Organization Name:ISIDRA VEVE M.D. PLLC
Other - Org Name:SOUTHLAKE ANESTHESIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ISIDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:VEVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-442-1250
Mailing Address - Street 1:410 N CARROLL AVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6455
Mailing Address - Country:US
Mailing Address - Phone:817-442-1250
Mailing Address - Fax:
Practice Address - Street 1:410 N CARROLL AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6455
Practice Address - Country:US
Practice Address - Phone:817-442-1250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7726207L00000X, 207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB53651Medicare UPIN