Provider Demographics
NPI:1306928304
Name:GREGORY D ALES DO PA
Entity type:Organization
Organization Name:GREGORY D ALES DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:R
Authorized Official - Last Name:LETARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-896-2900
Mailing Address - Street 1:PO BOX 293879
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78029-3879
Mailing Address - Country:US
Mailing Address - Phone:830-896-2900
Mailing Address - Fax:830-792-5952
Practice Address - Street 1:4242 MEDICAL DR STE 6100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5643
Practice Address - Country:US
Practice Address - Phone:830-896-2900
Practice Address - Fax:830-792-5952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2532084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI51334Medicare UPIN
TX00W391Medicare ID - Type Unspecified