Organization
GUADALUPE EAR, NOSE AND THROAT, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNIFER GAYE HENNESSEE M.D. (PRESIDENT)
(830) 379-0299
Entity
Organization
Contact information
Practice address
1414 E WALNUT ST, SEGUIN, TX 78155-5175
(830) 379-0299
(830) 401-0323
Mailing address
PO BOX 1266, SEGUIN, TX 78156-1266
(830) 379-0299
(830) 401-0323
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
M1754
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
177183401
—
TX
Enumeration date
09/25/2006
Last updated
10/11/2016
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