Healthcare Provider Details

I. General information

NPI: 1578693198
Provider Name (Legal Business Name): JENNIFER KREJCI-MANWARING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 06/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 MERTON MINTER ST # 1A AUDIE MURPHY VETERANS HOSPITAL
SAN ANTONIO TX
78229-4404
US

IV. Provider business mailing address

7400 MERTON MINTER ST # 1A AUDIE MURPHY VETERANS HOSPITAL
SAN ANTONIO TX
78229-4404
US

V. Phone/Fax

Practice location:
  • Phone: 210-949-9248
  • Fax: 210-949-3107
Mailing address:
  • Phone: 210-949-9248
  • Fax: 210-949-3107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberN0185
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: