MEDICARE: STONE OAK RHEUMATOLOGY PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	H2819	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A002	OTHER	TX	CHAMPUS
2	5397113	OTHER	TX	AETNA
3	00347R	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1235128240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STONE OAK RHEUMATOLOGY PA

Provider Business Mailing Address
First Line	:	155 E SONTERRA BLVD
Second Line	:	SUITE 211
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3987
Country	:	US
Telephone Number	:	210-490-1111
Fax Number	:	210-490-3833

Provider Business Practice Location Address
First Line	:	155 E SONTERRA BLVD
Second Line	:	SUITE 211
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3987
Country	:	US
Telephone Number	:	210-490-1111
Fax Number	:	210-490-3833

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LAURA A SUAREZ
Credential	:	MD
Telephone Number	:	210-490-1111

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	07/13/2007

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Directions to “STONE OAK RHEUMATOLOGY PA ” Practice Location

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