MEDICARE: HEALEY UROLOGY CLINIC, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician

General Provider Information

NPI Number	:	1114021631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALEY UROLOGY CLINIC, P.A.

Provider Business Mailing Address
First Line	:	3180 CENTRAL MALL DR
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-8039
Country	:	US
Telephone Number	:	409-729-6231
Fax Number	:	409-727-6537

Provider Business Practice Location Address
First Line	:	3180 CENTRAL MALL DR
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-8039
Country	:	US
Telephone Number	:	409-729-6231
Fax Number	:	409-727-6537

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GORDON BRUCE HEALEY
Credential	:	M.D.
Telephone Number	:	409-729-6231

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	08/22/2020

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