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General NPI Number Information
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NPI Number | 1104605161
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Entity Type | Organization
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Legal Business Name | TPG TEXAS PLLC
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Dates
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Enumeration Date | 09/27/2023
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Last Update Date | 09/27/2023
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Provider Practice Location Address
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Address Line | 26 BROADWAY STE 934
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City | NEW YORK
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State | NY
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Zip | 10004-1717
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Country | US
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Telephone | 628-260-5154
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 95590
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-0590
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HARVEY 1 CASTRO
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Credential | MD
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Telephone | 469-516-8039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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