Healthcare Provider Details

I. General information

NPI: 1831694579
Provider Name (Legal Business Name): ALEXANDRA WYNN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1248 AUSTIN HWY STE 214
SAN ANTONIO TX
78209-4867
US

IV. Provider business mailing address

2961 MOSSROCK
SAN ANTONIO TX
78230-5119
US

V. Phone/Fax

Practice location:
  • Phone: 210-828-2531
  • Fax: 210-828-2532
Mailing address:
  • Phone: 210-731-4800
  • Fax: 210-731-4810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberS9439
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: