Provider Demographics
NPI:1356761902
Name:TONY PITRE MD PA
Entity type:Organization
Organization Name:TONY PITRE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:PITRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-590-7773
Mailing Address - Street 1:10470 VISTA DEL SOL DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7948
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10470 VISTA DEL SOL DR
Practice Address - Street 2:SUITE 208
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7948
Practice Address - Country:US
Practice Address - Phone:915-590-7773
Practice Address - Fax:915-590-7782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7833207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG57792Medicare UPIN