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Organization
LAREDO PHYSICIANS GROUP
Active
Organization
LAREDO PHYSICIANS GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TODD EVANS (VP)
(610) 768-3300
Entity
Organization
Contact information
Practice address
10710 MCPHERSON RD, SUITE 300, LAREDO, TX 78045-6271
(956) 794-8853
(956) 523-3069
Mailing address
PO BOX 3046, MALVERN, PA 19355-0746
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207RG0100X
Gastroenterology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
208M00000X
Hospitalist Physician
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0087YV
BCBS
TX
05
—
323967501
—
TX
01
—
DV1690
RR MEDICARE
TX
Enumeration date
01/17/2013
Last updated
06/26/2019
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