Healthcare Provider Details

I. General information

NPI: 1336448356
Provider Name (Legal Business Name): RGV OB GYN ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 08/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 N ED CAREY DR
HARLINGEN TX
78550-7912
US

IV. Provider business mailing address

626 N ED CAREY DR
HARLINGEN TX
78550-7912
US

V. Phone/Fax

Practice location:
  • Phone: 956-428-4868
  • Fax: 210-579-2330
Mailing address:
  • Phone: 956-428-4868
  • Fax: 210-579-2330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberJ9584
License Number StateTX

VIII. Authorized Official

Name: DR. SUSAN DELORES HUNTER
Title or Position: OFFICER
Credential: M.D.
Phone: 956-428-4868