Provider Demographics
NPI:1699958124
Name:EAST TEXAS UROCENTER
Entity type:Organization
Organization Name:EAST TEXAS UROCENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:G
Authorized Official - Last Name:MOREIRA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:936-560-5200
Mailing Address - Street 1:1320 N UNIVERSITY DR STE A
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4270
Mailing Address - Country:US
Mailing Address - Phone:936-560-5200
Mailing Address - Fax:936-560-5222
Practice Address - Street 1:1320 N UNIVERSITY DR STE A
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4270
Practice Address - Country:US
Practice Address - Phone:936-560-5200
Practice Address - Fax:936-560-5222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8194208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty