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General NPI Number Information
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NPI Number | 1609125483
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Entity Type | Organization
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Legal Business Name | GREATER TEXAS SPINE & NEUROSURGERY PA
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Dates
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Enumeration Date | 09/07/2012
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Last Update Date | 09/07/2012
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Provider Practice Location Address
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Address Line | 2705 HOSPITAL DR SUITE 200
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City | VICTORIA
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State | TX
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Zip | 77901-5775
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Country | US
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Telephone | 361-582-7979
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Fax | 361-582-7977
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Provider Business Mailing Address
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Address Line | 2705 HOSPITAL DR SUITE 200
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City | VICTORIA
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State | TX
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Zip | 77901-5775
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Country | US
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Telephone | 361-582-7979
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Fax | 361-582-7977
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Authorized Official
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Title or Position | OWNER
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Name | TIMOTHY E SPENCER
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Credential | D.O.
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Telephone | 361-582-7979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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