Healthcare Provider Details

I. General information

NPI: 1336637990
Provider Name (Legal Business Name): JOHN SUDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2018
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8435 WURZBACH RD STE 305
SAN ANTONIO TX
78229-3374
US

IV. Provider business mailing address

5114 MEDICAL DR
SAN ANTONIO TX
78229-3764
US

V. Phone/Fax

Practice location:
  • Phone: 210-450-9800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberT0636
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberT0636
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: