Provider Demographics
NPI:1851353700
Name:GERALD A PRICE, MD, PA
Entity Type:Organization
Organization Name:GERALD A PRICE, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-792-3283
Mailing Address - Street 1:PO BOX 291790
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78029-1790
Mailing Address - Country:US
Mailing Address - Phone:830-792-3283
Mailing Address - Fax:830-792-3288
Practice Address - Street 1:306 A WESLEY DRIVE
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028
Practice Address - Country:US
Practice Address - Phone:830-792-3283
Practice Address - Fax:830-792-3288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8724207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164205004Medicaid
TX00912WOtherBCBS
TX164205003Medicaid
TX171211901OtherMEDICAID GRP #
TX1770546178OtherNPI INDIVIDUAL #
TX164205001Medicaid
TX164205002Medicaid
TX1770546178OtherNPI INDIVIDUAL #