Healthcare Provider Details

I. General information

NPI: 1871789867
Provider Name (Legal Business Name): TOEPPERWEIN FAMILY PRACTICE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 01/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11355 TOEPPERWEIN RD
LIVE OAK TX
78233-3230
US

IV. Provider business mailing address

11355 TOEPPERWEIN ROAD
LIVE OAK TX
78233-3230
US

V. Phone/Fax

Practice location:
  • Phone: 210-654-7200
  • Fax: 210-654-7211
Mailing address:
  • Phone: 210-654-7200
  • Fax: 210-654-7211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberJ7223
License Number StateTX

VIII. Authorized Official

Name: DR. MOIZ A TAJKHANJI
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 210-654-7200