Basic Information
| Provider Information | |||||||||
| NPI: | 1124077821 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIDLA | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | STEPHEN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MIDLA | ||||||||
| OtherFirstName: | GEORGE | ||||||||
| OtherMiddleName: | STEPHEN | ||||||||
| OtherNamePrefix: | MR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PA-C | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2161 NW MILITARY HWY | ||||||||
| Address2: | STE. 308 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782131878 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103413336 | ||||||||
| FaxNumber: | 2103413455 | ||||||||
| Practice Location | |||||||||
| Address1: | 2537 GARDEN AVE | ||||||||
| Address2: | INSTITUTE OF SURGICAL RESEARCH | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2108084238 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2006 | ||||||||
| LastUpdateDate: | 05/28/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA07734 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AS0400X | 1041460 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.