Provider Demographics
NPI:1962506386
Name:TEXAS ENDOSURGERY ASSOCIATES
Entity Type:Organization
Organization Name:TEXAS ENDOSURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:M
Authorized Official - Last Name:BONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-579-5638
Mailing Address - Street 1:21720 KINGSLAND BOULEVARD, SUITE 303A
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450
Mailing Address - Country:US
Mailing Address - Phone:281-579-5638
Mailing Address - Fax:281-579-5636
Practice Address - Street 1:21720 KINGSLAND BOULEVARD, SUITE 303A
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450
Practice Address - Country:US
Practice Address - Phone:281-579-5638
Practice Address - Fax:281-579-5636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00X613Medicare PIN