Basic Information
| Provider Information | |||||||||
| NPI: | 1376145458 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SYNOVATION MEDICAL GROUP TEXAS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 224 N FAIR OAKS AVE STE 300 | ||||||||
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| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911033618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6266961481 | ||||||||
| FaxNumber: | 6266961451 | ||||||||
| Practice Location | |||||||||
| Address1: | 3705 MEDICAL PKWY STE 430 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7372565900 | ||||||||
| FaxNumber: | 7376675011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2020 | ||||||||
| LastUpdateDate: | 07/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | VARGA | ||||||||
| AuthorizedOfficialFirstName: | CLAYTON | ||||||||
| AuthorizedOfficialMiddleName: | ALEXANDER | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6266961400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 07/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | 208VP0000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.