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General NPI Number Information
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NPI Number | 1972917888
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Entity Type | Organization
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Legal Business Name | SOUTH TEXAS NEUROLOGY LLC
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Dates
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Enumeration Date | 06/18/2014
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Last Update Date | 10/24/2014
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Provider Practice Location Address
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Address Line | 115 GALLERY CIR STE 300
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City | SAN ANTONIO
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State | TX
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Zip | 78258-3388
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Country | US
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Telephone | 210-403-2074
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Fax | 210-403-2078
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Provider Business Mailing Address
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Address Line | PO BOX 592629
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City | SAN ANTONIO
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State | TX
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Zip | 78259-0181
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Country | US
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Telephone | 210-403-2074
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Fax | 210-403-2078
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. PRAVEEN KUMAR THANGADA
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Credential | M.D.
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Telephone | 210-403-2074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | J7226
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License Number State | TX
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