Provider Demographics
NPI:1831149632
Name:KERRVILLE ALLERGY AND ASTHMA ASSOCIATES, P.A.
Entity type:Organization
Organization Name:KERRVILLE ALLERGY AND ASTHMA ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-896-1433
Mailing Address - Street 1:708 HILL COUNTRY DR.,
Mailing Address - Street 2:STE 400
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-6071
Mailing Address - Country:US
Mailing Address - Phone:830-896-1433
Mailing Address - Fax:830-896-1440
Practice Address - Street 1:708 HILL COUNTRY DR.,
Practice Address - Street 2:STE 400
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-6071
Practice Address - Country:US
Practice Address - Phone:830-896-1433
Practice Address - Fax:830-896-1440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX ID NUMBER
TX=========OtherTAX ID NUMBER
TX8941J0Medicare UPIN