Healthcare Provider Details

I. General information

NPI: 1669625448
Provider Name (Legal Business Name): REZA ABBAS ALI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2008
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12011 STATE HIGHWAY 151 STE 202
SAN ANTONIO TX
78251-1230
US

IV. Provider business mailing address

215 N SAN SABA STE 301
SAN ANTONIO TX
78207-3164
US

V. Phone/Fax

Practice location:
  • Phone: 210-265-8155
  • Fax: 210-477-4750
Mailing address:
  • Phone: 210-212-8622
  • Fax: 210-212-9197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number26338
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberR4355
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: