MEDICARE: MISS ELLEN ELIZABETH SUGAREK PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant		TX

General Provider Information

NPI Number	:	1831372259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ELLEN ELIZABETH SUGAREK PA-C

Provider Business Mailing Address
First Line	:	2700 E 29TH ST
Second Line	:	SUITE 235
City	:	BRYAN
State	:	TX
Zip	:	77802-2531
Country	:	US
Telephone Number	:	979-774-4008
Fax Number	:	979-731-8914

Provider Business Practice Location Address
First Line	:	2700 E 29TH ST
Second Line	:	SUITE 235
City	:	BRYAN
State	:	TX
Zip	:	77802-2531
Country	:	US
Telephone Number	:	979-774-4008
Fax Number	:	979-731-8914

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2007
Last Update Date	:	10/21/2010

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