Provider Demographics
NPI:1952511339
Name:MEMORIAL UROLOGY ASSOCIATES, PA
Entity Type:Organization
Organization Name:MEMORIAL UROLOGY ASSOCIATES, PA
Other - Org Name:MEMORIAL UROLOGY ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:A
Authorized Official - Last Name:SELZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-830-9200
Mailing Address - Street 1:915 GESSNER RD
Mailing Address - Street 2:SUITE 720
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2527
Mailing Address - Country:US
Mailing Address - Phone:713-830-9200
Mailing Address - Fax:
Practice Address - Street 1:7907 FREDRICKSBURG
Practice Address - Street 2:SUITE 150 RM J
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:713-830-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084518202Medicaid
TXP00603909OtherRAILROAD MEDICARE
TX084518202Medicaid