Provider Demographics
NPI:1396842084
Name:POULOS, SAVVAS C (MD)
Entity type:Individual
Prefix:
First Name:SAVVAS
Middle Name:C
Last Name:POULOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1330 E 6TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-4204
Mailing Address - Country:US
Mailing Address - Phone:956-969-5237
Mailing Address - Fax:956-968-9290
Practice Address - Street 1:1401 E 8TH ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6640
Practice Address - Country:US
Practice Address - Phone:956-969-5237
Practice Address - Fax:956-968-6290
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8091207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0355935-06Medicaid
TX8J6134OtherMEDICARE PTAN
TX0355935-05Medicaid
TX0355935-06Medicaid