Provider Demographics
NPI:1447362132
Name:GASTROENTEROLOGY ASSOCIATES OF TEXAS PA
Entity type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES OF TEXAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:LANCE
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-201-1338
Mailing Address - Street 1:17510 W GRAND PKWY S
Mailing Address - Street 2:#220
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2645
Mailing Address - Country:US
Mailing Address - Phone:281-201-1338
Mailing Address - Fax:281-201-1353
Practice Address - Street 1:17510 W GRAND PKWY S
Practice Address - Street 2:STE 220
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2645
Practice Address - Country:US
Practice Address - Phone:281-201-1338
Practice Address - Fax:281-201-1353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7479174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty