Healthcare Provider Details

I. General information

NPI: 1932117108
Provider Name (Legal Business Name): KERMIT SPEEG JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7979 WURZBACH RD # MC7977
SAN ANTONIO TX
78229-4427
US

IV. Provider business mailing address

7979 WURZBACH RD # MC7977
SAN ANTONIO TX
78229-4427
US

V. Phone/Fax

Practice location:
  • Phone: 210-450-9000
  • Fax:
Mailing address:
  • Phone: 210-450-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG4718
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberG4718
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: