Provider Demographics
NPI:1912213398
Name:GARY M. SONGCO PA
Entity Type:Organization
Organization Name:GARY M. SONGCO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SONGCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-226-5933
Mailing Address - Street 1:61 LONGSFORD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1820
Mailing Address - Country:US
Mailing Address - Phone:210-226-5933
Mailing Address - Fax:210-226-6433
Practice Address - Street 1:61 LONGSFORD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1820
Practice Address - Country:US
Practice Address - Phone:210-226-5933
Practice Address - Fax:210-226-6433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2183174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097514601Medicaid
00B45PMedicare UPIN