Healthcare Provider Details

I. General information

NPI: 1033436571
Provider Name (Legal Business Name): DRISCOLL PHYSICIANS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3533 S ALAMEDA ST SUITE 200
CORPUS CHRISTI TX
78411-1721
US

IV. Provider business mailing address

3533 S ALAMEDA ST SUITE 200
CORPUS CHRISTI TX
78411-1721
US

V. Phone/Fax

Practice location:
  • Phone: 361-694-5086
  • Fax: 361-855-9518
Mailing address:
  • Phone: 361-694-5086
  • Fax: 361-855-9518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number1004
License Number StateNC

VIII. Authorized Official

Name: DR. HERBERT JOEL STERN
Title or Position: PEDICATRIC CARDIOLOGY
Credential: MD
Phone: 361-694-5086