MEDICARE: DR. EDMUNDO REVERON-QUESTELL MD MPH

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	207P00000X	Emergency Medicine Physician	F0294	TX
2	207Q00000X	Family Medicine Physician	F0294	TX

General Provider Information

NPI Number	:	1548206774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDMUNDO REVERON-QUESTELL MD MPH

Provider Business Mailing Address
First Line	:	4335 W PIEDRAS DR
Second Line	:	STE 103
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-1215
Country	:	US
Telephone Number	:	210-600-4117
Fax Number	:	210-600-3849

Provider Business Practice Location Address
First Line	:	4335 W PIEDRAS DR
Second Line	:	STE 103
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-1215
Country	:	US
Telephone Number	:	210-600-4117
Fax Number	:	210-600-3849

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	08/27/2021

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