Provider Demographics
NPI:1114290624
Name:SOUTH TEXAS ORTHOPEDIC SPECIALTY GROUP, PLLC
Entity type:Organization
Organization Name:SOUTH TEXAS ORTHOPEDIC SPECIALTY GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:DMITRY
Authorized Official - Middle Name:
Authorized Official - Last Name:TUDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-598-5605
Mailing Address - Street 1:10010 ROGERS XING STE 308
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4776
Mailing Address - Country:US
Mailing Address - Phone:210-598-5605
Mailing Address - Fax:210-598-5620
Practice Address - Street 1:10010 ROGERS XING STE 308
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4776
Practice Address - Country:US
Practice Address - Phone:210-598-5605
Practice Address - Fax:210-598-5620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty