Healthcare Provider Details

I. General information

NPI: 1912946427
Provider Name (Legal Business Name): SOUTH SAN ANTONIO MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2207 S ZARZAMORA ST
SAN ANTONIO TX
78207-8005
US

IV. Provider business mailing address

11765 WEST AVEUNE PMB 192
SAN ANTONIO TX
78216
US

V. Phone/Fax

Practice location:
  • Phone: 210-223-3863
  • Fax: 210-224-6305
Mailing address:
  • Phone: 210-924-7158
  • Fax: 210-924-4642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberJ5950
License Number StateTX

VIII. Authorized Official

Name: DR. RONALD D WONG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 210-924-7158