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General NPI Number Information
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NPI Number | 1194260646
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Entity Type | Organization
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Legal Business Name | EL PASO SPECIALTY PHYSICIANS GROUP
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Dates
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Enumeration Date | 12/19/2016
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Last Update Date | 12/19/2016
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Provider Practice Location Address
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Address Line | 1720 MURCHISON DR
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City | EL PASO
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State | TX
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Zip | 79902-2921
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Country | US
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Telephone | 915-534-1051
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Fax |
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Provider Business Mailing Address
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Address Line | 1720 MURCHISON DR
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City | EL PASO
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State | TX
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Zip | 79902-2921
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Country | US
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Telephone | 915-534-1051
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | JAMES WILCOX
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Credential | MBA
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Telephone | 19155341051
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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 | 657839
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 657839
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 657839
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License Number State | TX
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