1811088305 NPI number — MR. GILBERTO SAENZ III PHYSICIAN ASSISTANT

Table of content: MR. GILBERTO SAENZ III PHYSICIAN ASSISTANT (NPI 1811088305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811088305 NPI number — MR. GILBERTO SAENZ III PHYSICIAN ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAENZ
Provider First Name:
GILBERTO
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
III
Provider Credential Text:
PHYSICIAN ASSISTANT
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:
1811088305
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3010 WILLIAMS DR
Provider Second Line Business Mailing Address:
SUITE 177
Provider Business Mailing Address City Name:
GEORGETOWN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78628-2764
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-930-3909
Provider Business Mailing Address Fax Number:
512-869-5868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3010 WILLIAMS DR
Provider Second Line Business Practice Location Address:
SUITE 177
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78628-2764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-930-3909
Provider Business Practice Location Address Fax Number:
512-869-5868
Provider Enumeration Date:
09/27/2006

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: 363AS0400X , with the licence number:  PA03581 , 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: 289387701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8Y5211 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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