Provider Demographics
NPI:1063541589
Name:G R ALBERTSON DO PA
Entity type:Organization
Organization Name:G R ALBERTSON DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:ALBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:512-338-4336
Mailing Address - Street 1:4407 BEE CAVE RD
Mailing Address - Street 2:#113
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6405
Mailing Address - Country:US
Mailing Address - Phone:512-338-4336
Mailing Address - Fax:512-343-8197
Practice Address - Street 1:4407 BEE CAVE RD
Practice Address - Street 2:#113
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6405
Practice Address - Country:US
Practice Address - Phone:512-338-4336
Practice Address - Fax:512-343-8197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7899207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA65286Medicare UPIN