Organization
GENESIS GYNECOLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KERRI LEE TRUELOCK MD (PRESIDENT)
(830) 792-0805
Entity
Organization
Contact information
Practice address
176 FAIRWAY DR, KERRVILLE, TX 78028-6437
(830) 792-0805
(830) 792-0833
Mailing address
176 FAIRWAY DR, KERRVILLE, TX 78028-6437
(830) 792-0805
(830) 792-0833
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
TX
207V00000X
Obstetrics & Gynecology Physician
—
—
207VG0400X
Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0083RB
BCBS OF TEXAS GROUP #
TX
05
—
193308701
—
TX
Enumeration date
02/27/2008
Last updated
03/13/2013
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