Organization
GASTROENTEROLOGY CLINIC OF SAN ANTONIO, P.A.
Active
Organization
GASTROENTEROLOGY CLINIC OF SAN ANTONIO, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL HAVRANEK MD (CEO)
(210) 615-8308
Entity
Organization
Contact information
Practice address
8550 DATAPOINT DR, SUITE 200, SAN ANTONIO, TX 78229-3270
(210) 615-8308
(210) 615-8313
Mailing address
8550 DATAPOINT DR, SUITE 200, SAN ANTONIO, TX 78229-3270
(210) 615-8308
(210) 615-8313
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00BL45
MEDICARE PTAN
TX
05
—
044080201
—
TX
Enumeration date
11/03/2006
Last updated
10/29/2015
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