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General NPI Number Information
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NPI Number | 1114159357
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Entity Type | Organization
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Legal Business Name | GUADALUPE VALLEY SURGICAL ASSOCIATES PA
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Dates
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Enumeration Date | 08/21/2009
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Last Update Date | 08/26/2011
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Provider Practice Location Address
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Address Line | 420 E 6TH ST STE 104
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City | ODESSA
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State | TX
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Zip | 79761-4537
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Country | US
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Telephone | 432-333-8400
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Fax | 432-333-8401
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Provider Business Mailing Address
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Address Line | 420 E 6TH ST STE 104
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City | ODESSA
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State | TX
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Zip | 79761-4537
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Country | US
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Telephone | 432-333-8400
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Fax | 432-333-8401
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Authorized Official
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Title or Position | OWNER/MD
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Name | DR. STEVEN WADE FATH
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Credential | MD
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Telephone | 432-333-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | K8144
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License Number State | TX
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