Healthcare Provider Details

I. General information

NPI: 1336268556
Provider Name (Legal Business Name): BEXAR DIAGNOSTIC MEDICINE ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5430 FREDERICKSBURG RD SUITE 400
SAN ANTONIO TX
78229-3539
US

IV. Provider business mailing address

5430 FREDERICKSBURG RD SUITE 400
SAN ANTONIO TX
78229-3539
US

V. Phone/Fax

Practice location:
  • Phone: 210-692-3362
  • Fax: 210-616-3558
Mailing address:
  • Phone: 210-692-3362
  • Fax: 210-616-3558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. ELIZABETH SANCHEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 210-692-3362