Healthcare Provider Details

I. General information

NPI: 1093198970
Provider Name (Legal Business Name): SOUTH TEXAS SURGICAL ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20770 US HIGHWAY 281 N #108-439
SAN ANTONIO TX
78258-7519
US

IV. Provider business mailing address

PO BOX 8308
SPRING TX
77387-8308
US

V. Phone/Fax

Practice location:
  • Phone: 281-820-1900
  • Fax: 281-820-1901
Mailing address:
  • Phone: 800-785-8765
  • Fax: 281-820-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: ADAM BRUGGEMAN
Title or Position: MBR
Credential: M.D.
Phone: 210-373-3704