Basic Information
| Provider Information | |||||||||
| NPI: | 1700836756 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHWEST BARIATRIC SURGEONS PLLC | ||||||||
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| OtherOrganizationName: | SHERROD MARK R MEMBER C/O MARK R SHERROD | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3705 MEDICAL PKWY STE 210 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123021210 | ||||||||
| FaxNumber: | 5124519752 | ||||||||
| Practice Location | |||||||||
| Address1: | 3705 MEDICAL PKWY STE 210 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123021210 | ||||||||
| FaxNumber: | 5124519752 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 02/03/2021 | ||||||||
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| AuthorizedOfficialLastName: | CLARKE | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5123341890 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.