1235341835 NPI number — MR. GERALD ROSS ADCOCK PT

Table of content: MR. GERALD ROSS ADCOCK PT (NPI 1235341835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235341835 NPI number — MR. GERALD ROSS ADCOCK PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADCOCK
Provider First Name:
GERALD
Provider Middle Name:
ROSS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235341835
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1045 CENTRAL PARKWAY NORTH
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78232-5024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-541-4500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3453 IH35 NORTH SUITE 207 B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-227-8080
Provider Business Practice Location Address Fax Number:
210-298-2658
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1043099 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1043099 . This is a "TX LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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