Provider Demographics
NPI:1104157106
Name:REMEDIOS R. CABANSAG , MD, PA
Entity type:Organization
Organization Name:REMEDIOS R. CABANSAG , MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT,VICE PRESIDENT,SEC/TREAS
Authorized Official - Prefix:DR
Authorized Official - First Name:REMEDIOS
Authorized Official - Middle Name:R
Authorized Official - Last Name:CABANSAG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-551-2963
Mailing Address - Street 1:11803 SO. FREEWAY
Mailing Address - Street 2:SUITE 254
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76115-0337
Mailing Address - Country:US
Mailing Address - Phone:817-551-2963
Mailing Address - Fax:817-568-1663
Practice Address - Street 1:11803 SO. FREEWAY
Practice Address - Street 2:SUITE 254
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76115-0337
Practice Address - Country:US
Practice Address - Phone:817-551-2963
Practice Address - Fax:817-568-1663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9958207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114071701Medicaid
TX114071701Medicaid