Healthcare Provider Details

I. General information

NPI: 1407963473
Provider Name (Legal Business Name): JAN MARIE BRUDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 FLOYD CURL DR 3RD FL - 3A
SAN ANTONIO TX
78229-3931
US

IV. Provider business mailing address

7703 FLOYD CURL DR
SAN ANTONIO TX
78229-3901
US

V. Phone/Fax

Practice location:
  • Phone: 210-450-9490
  • Fax:
Mailing address:
  • Phone: 210-450-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberK1784
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: