Healthcare Provider Details

I. General information

NPI: 1215229992
Provider Name (Legal Business Name): NEIL F HADDOCK MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E SONTERRA BLVD STE 110
SAN ANTONIO TX
78258-4055
US

IV. Provider business mailing address

325 E SONTERRA BLVD STE 110
SAN ANTONIO TX
78258-4055
US

V. Phone/Fax

Practice location:
  • Phone: 210-496-5792
  • Fax:
Mailing address:
  • Phone: 210-496-5792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberF9519
License Number StateTX

VIII. Authorized Official

Name: NEIL HADDOCK
Title or Position: OWNER
Credential: MD
Phone: 210-496-5792