Healthcare Provider Details

I. General information

NPI: 1366489262
Provider Name (Legal Business Name): NORTHWEST ANESTHESIOLOGY SA, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 01/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 NE LOOP 410 SUITE 900
SAN ANTONIO TX
78216-5832
US

IV. Provider business mailing address

45 NE LOOP 410 SUITE 900
SAN ANTONIO TX
78216-5832
US

V. Phone/Fax

Practice location:
  • Phone: 210-375-7780
  • Fax: 210-375-7789
Mailing address:
  • Phone: 210-375-7780
  • Fax: 210-375-7789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES MICHAEL WYNN
Title or Position: PARTNER
Credential: MD
Phone: 210-477-2409