Provider Demographics
NPI:1972094365
Name:SOUTHERN TEXAS ALLERGY THE WOODLANDS
Entity Type:Organization
Organization Name:SOUTHERN TEXAS ALLERGY THE WOODLANDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:512-637-1797
Mailing Address - Street 1:PO BOX 202110
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78720-2110
Mailing Address - Country:US
Mailing Address - Phone:512-637-1797
Mailing Address - Fax:855-959-1863
Practice Address - Street 1:9191 PINECROFT DR STE 290
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380
Practice Address - Country:US
Practice Address - Phone:281-363-3508
Practice Address - Fax:281-298-7787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty