Healthcare Provider Details

I. General information

NPI: 1043301120
Provider Name (Legal Business Name): JOSE M PUJOL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12702 IH35 N
LIVE OAK TX
78233-2609
US

IV. Provider business mailing address

8109 FREDERICKSBURG RD PHYSICIAN PRACTICE SERVICES
SAN ANTONIO TX
78229-3311
US

V. Phone/Fax

Practice location:
  • Phone: 210-650-9669
  • Fax: 210-650-0750
Mailing address:
  • Phone: 210-650-9669
  • Fax: 210-650-0750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberJ3879
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberJ3879
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: