Provider Demographics
NPI:1982828604
Name:SOUTHEAST TEXAS NEUROLOGY,PA
Entity Type:Organization
Organization Name:SOUTHEAST TEXAS NEUROLOGY,PA
Other - Org Name:MEDICAL NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMEM
Authorized Official - Middle Name:D
Authorized Official - Last Name:UDONTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-983-2711
Mailing Address - Street 1:2300 HIGHWAY 365 STE 600
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-6258
Mailing Address - Country:US
Mailing Address - Phone:409-983-2711
Mailing Address - Fax:409-853-1641
Practice Address - Street 1:2300 HIGHWAY 365 STE 600
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-6258
Practice Address - Country:US
Practice Address - Phone:409-983-2711
Practice Address - Fax:409-853-1641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130004816OtherMEDICARE RAILROAD
TX00L34GMedicare PIN