Provider Demographics
NPI:1912226606
Name:TEXAS UROLOGY ALLIANCE,PA
Entity type:Organization
Organization Name:TEXAS UROLOGY ALLIANCE,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:MAYMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-982-7190
Mailing Address - Street 1:844 CENTRAL BLVD
Mailing Address - Street 2:STE 430
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-7552
Mailing Address - Country:US
Mailing Address - Phone:956-982-7190
Mailing Address - Fax:956-982-7191
Practice Address - Street 1:844 CENTRAL BLVD
Practice Address - Street 2:STE 430
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7552
Practice Address - Country:US
Practice Address - Phone:956-982-7190
Practice Address - Fax:956-982-7191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4331208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty