Healthcare Provider Details

I. General information

NPI: 1245520089
Provider Name (Legal Business Name): SAN ANTONIO INTERNAL MEDICINE PHYSICIANS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 07/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12702 IH 35 N
SAN ANTONIO TX
78233-2609
US

IV. Provider business mailing address

8109 FREDERICKSBURG RD PHYSICIAN PRACTICE SERVICES
SAN ANTONIO TX
78229-3311
US

V. Phone/Fax

Practice location:
  • Phone: 210-650-9669
  • Fax: 210-650-0750
Mailing address:
  • Phone: 210-575-8501
  • Fax: 210-575-0167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERTA S CLOUD
Title or Position: VICE PRESIDENT
Credential:
Phone: 210-575-8501