Healthcare Provider Details

I. General information

NPI: 1033630223
Provider Name (Legal Business Name): I VASCULAR OF EL PASO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 06/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11989 PELLICANO DR STE D
EL PASO TX
79936-6288
US

IV. Provider business mailing address

19234 STONEHUE
SAN ANTONIO TX
78258-3477
US

V. Phone/Fax

Practice location:
  • Phone: 210-240-9996
  • Fax:
Mailing address:
  • Phone: 210-481-9544
  • Fax: 210-481-9545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANWAR GERGES
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 210-240-9996