Provider Demographics
NPI:1265075618
Name:TEXAS LONE STAR PHYSICIAN SERVICES, PLLC
Entity type:Organization
Organization Name:TEXAS LONE STAR PHYSICIAN SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:GARAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-248-7417
Mailing Address - Street 1:987 WITHERSPOON LOOP
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78046-8823
Mailing Address - Country:US
Mailing Address - Phone:432-248-7417
Mailing Address - Fax:
Practice Address - Street 1:2005 E BUSTAMANTE ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5470
Practice Address - Country:US
Practice Address - Phone:956-753-5353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty