MEDICARE: DR. JOHN DENNIS CAYANAN ALFONSO M.D.

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	208100000X	Physical Medicine & Rehabilitation Physician	P4538	TX

General Provider Information

NPI Number	:	1558595660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN DENNIS CAYANAN ALFONSO M.D.

Provider Business Mailing Address
First Line	:	17503 LA CANTERA PKWY # 104-456
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-8207
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17503 LA CANTERA PKWY # 104-456
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-8207
Country	:	US
Telephone Number	:	210-571-7100
Fax Number	:

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

Provider Enumeration Date	:	05/05/2009
Last Update Date	:	10/09/2019

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