Provider Demographics
NPI:1982807699
Name:GVSA MEDICAL PROFESSIONALS, PLLC
Entity Type:Organization
Organization Name:GVSA MEDICAL PROFESSIONALS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-776-5631
Mailing Address - Street 1:2700 E 29TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2531
Mailing Address - Country:US
Mailing Address - Phone:979-776-5631
Mailing Address - Fax:
Practice Address - Street 1:2700 E 29TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2531
Practice Address - Country:US
Practice Address - Phone:979-776-5631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080961801Medicaid
TX080961801Medicaid