Provider Demographics
NPI:1124077821
Name:MIDLA, GEORGE STEPHEN (PA-C)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:STEPHEN
Last Name:MIDLA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:GEORGE
Other - Middle Name:STEPHEN
Other - Last Name:MIDLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:2161 NW MILITARY HWY
Mailing Address - Street 2:STE. 308
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1878
Mailing Address - Country:US
Mailing Address - Phone:210-341-3336
Mailing Address - Fax:210-341-3455
Practice Address - Street 1:2537 GARDEN AVE
Practice Address - Street 2:INSTITUTE OF SURGICAL RESEARCH
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213
Practice Address - Country:US
Practice Address - Phone:210-808-4238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07734363AM0700X
WA1041460363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical