Healthcare Provider Details

I. General information

NPI: 1689688608
Provider Name (Legal Business Name): SEGUNDO ABRAHAM BRIONES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16614 SAN PEDRO AVE
SAN ANTONIO TX
78232-2223
US

IV. Provider business mailing address

16614 SAN PEDRO AVE
SAN ANTONIO TX
78232-2223
US

V. Phone/Fax

Practice location:
  • Phone: 210-495-6515
  • Fax: 210-495-4565
Mailing address:
  • Phone: 210-495-6515
  • Fax: 210-495-4565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberJ8930
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: