Provider Demographics
NPI:1043498470
Name:EARS OF TEXAS, P.A.
Entity type:Organization
Organization Name:EARS OF TEXAS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:WO
Authorized Official - Last Name:KRUEGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-697-0880
Mailing Address - Street 1:2632 BROADWAY ST
Mailing Address - Street 2:SUITE 201-202
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-1137
Mailing Address - Country:US
Mailing Address - Phone:210-697-0880
Mailing Address - Fax:210-697-0888
Practice Address - Street 1:2632 BROADWAY ST
Practice Address - Street 2:SUITE 201-202
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1137
Practice Address - Country:US
Practice Address - Phone:210-697-0880
Practice Address - Fax:210-697-0888
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EARS OF TEXAS, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4463174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB24133Medicare UPIN