Healthcare Provider Details

I. General information

NPI: 1689104846
Provider Name (Legal Business Name): DIRECT MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 NW LOOP 410 STE 100A
SAN ANTONIO TX
78213-2220
US

IV. Provider business mailing address

1010 NW LOOP 410 STE 100A
SAN ANTONIO TX
78213-2220
US

V. Phone/Fax

Practice location:
  • Phone: 210-886-8031
  • Fax: 210-886-8059
Mailing address:
  • Phone: 210-886-8031
  • Fax: 210-886-8059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROGER MOCZYGEMBA
Title or Position: OWNER
Credential: MD
Phone: 210-264-5500