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General NPI Number Information
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NPI Number | 1700893849
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Entity Type | Organization
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Legal Business Name | MISSION DOCTORS GROUP
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 910 S BRYAN RD STE 103
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City | MISSION
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State | TX
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Zip | 78572-6615
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Country | US
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Telephone | 956-598-7000
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Fax | 956-598-7001
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Provider Business Mailing Address
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Address Line | 910 S BRYAN RD STE 103
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City | MISSION
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State | TX
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Zip | 78572-6615
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Country | US
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Telephone | 956-598-7000
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Fax | 956-598-7001
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Authorized Official
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Title or Position | CFO
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Name | LESTER EDWARD SURROCK
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Credential | CPA
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Telephone | 956-323-9106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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