Healthcare Provider Details

I. General information

NPI: 1043246846
Provider Name (Legal Business Name): KAREN SUE SHIMOTSU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15102 HUEBNER RD
SAN ANTONIO TX
78231-1739
US

IV. Provider business mailing address

PO BOX 734812
DALLAS TX
75373-4812
US

V. Phone/Fax

Practice location:
  • Phone: 210-493-3993
  • Fax: 210-493-1521
Mailing address:
  • Phone: 210-358-9500
  • Fax: 210-358-9183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH2779
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: