Healthcare Provider Details

I. General information

NPI: 1316916828
Provider Name (Legal Business Name): MARK E. KUYN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13722 EMBASSY ROW
SAN ANTONIO TX
78216-2000
US

IV. Provider business mailing address

13722 EMBASSY ROW
SAN ANTONIO TX
78216-2000
US

V. Phone/Fax

Practice location:
  • Phone: 210-349-5577
  • Fax: 210-491-2868
Mailing address:
  • Phone: 210-349-5577
  • Fax: 210-491-2868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL6997
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: