| South Texas Neurobehavioral Group Llc | |
|
3603 Paesanos Pkwy Suite 300 San Antonio TX 78231-1267 | |
| (210) 614-3011 | |
| (210) 615-6906 |
| Full Name | South Texas Neurobehavioral Group Llc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 3603 Paesanos Pkwy, San Antonio, Texas |
| Authorized Official Name and Position | Douglas B. Cooper (PRESIDENT) |
| Authorized Official Contact | 2102412555 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Texas Neurobehavioral Group Llc Po Box 782087 San Antonio TX 78278-2087 Ph: (210) 241-2555 | South Texas Neurobehavioral Group Llc 3603 Paesanos Pkwy Suite 300 San Antonio TX 78231-1267 Ph: (210) 614-3011 |
| NPI Number | 1568738763 |
|---|---|
| Provider Enumeration Date | 04/02/2012 |
| Last Update Date | 04/02/2012 |
| Medicare PECOS PAC ID | 9638335151 |
|---|---|
| Medicare Enrollment ID | O20120726000670 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568738763 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 32263 (Texas) | Primary |
| Provider Name | Douglas B Cooper |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1629056734 PECOS PAC ID: 1254233612 Enrollment ID: I20040126000136 |
| Provider Name | Gilbert Martinez |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1407971138 PECOS PAC ID: 8123200524 Enrollment ID: I20110307000446 |
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