Provider Demographics
NPI:1295870152
Name:LONE STAR GASTROENTEROLOGY, P.A.
Entity type:Organization
Organization Name:LONE STAR GASTROENTEROLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GOWRI
Authorized Official - Middle Name:
Authorized Official - Last Name:BALACHANDAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-867-7070
Mailing Address - Street 1:4101 W SPRING CREEK PKWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5307
Mailing Address - Country:US
Mailing Address - Phone:972-867-7070
Mailing Address - Fax:972-867-7878
Practice Address - Street 1:4101 W SPRING CREEK PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-5307
Practice Address - Country:US
Practice Address - Phone:972-867-7070
Practice Address - Fax:972-867-7878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4363207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158049001Medicaid
TX158049001Medicaid
TX00119VMedicare ID - Type Unspecified