Doctor Name: | DR. JOHN ABRAHAM GORITSAS |
NPI Number: | 1154741882 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | BP10049316 |
Business Practice Address: | 10204 Pantera Rdg Austin, TX - 787596918 |
Business Phone Number: | 7732718203 |
Business Fax Number: | |
Mailing Address: | 5055 Von Scheele Dr, Apt 827 SAN ANTONIO |
State: | TX |
Postal Code: | 782294354 |
Phone Number: | 2109012755 |
Fax Number: | |
NPI Enumeration Date: | 04/21/2014 |
NPI Last Update Date: | 05/23/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | BP10049316 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |