Healthcare Provider Details

I. General information

NPI: 1992297816
Provider Name (Legal Business Name): PAK MEDICAL GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1762 E COMMON ST
NEW BRAUNFELS TX
78130-6059
US

IV. Provider business mailing address

425 W COLONIAL DR STE 303
ORLANDO FL
32804-6863
US

V. Phone/Fax

Practice location:
  • Phone: 830-730-8580
  • Fax: 830-327-1021
Mailing address:
  • Phone: 321-343-6833
  • Fax: 407-286-4515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VERONICA JEAN HARLAN
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 106-302-2072