Provider Demographics
NPI:1801109772
Name:GULF CAOST NEUROPHYSIOLOGY ASSOCIATES, PLLC
Entity type:Organization
Organization Name:GULF CAOST NEUROPHYSIOLOGY ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:NORVILL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:210-854-9488
Mailing Address - Street 1:607 BASSWOOD ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-9694
Mailing Address - Country:US
Mailing Address - Phone:210-854-9488
Mailing Address - Fax:
Practice Address - Street 1:607 BASSWOOD ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-9694
Practice Address - Country:US
Practice Address - Phone:210-854-9488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty