Provider Demographics
NPI:1902947724
Name:SURESH J ANTONY M D P A
Entity Type:Organization
Organization Name:SURESH J ANTONY M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANTONY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-525-1138
Mailing Address - Street 1:1205 N OREGON ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4023
Mailing Address - Country:US
Mailing Address - Phone:915-533-4900
Mailing Address - Fax:915-533-4902
Practice Address - Street 1:1205 N OREGON ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4023
Practice Address - Country:US
Practice Address - Phone:915-533-4900
Practice Address - Fax:915-533-4902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0610207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00X214Medicare PIN