Healthcare Provider Details

I. General information

NPI: 1760483291
Provider Name (Legal Business Name): DONALD LONG HILTON JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 MEDICAL DR STE 610
SAN ANTONIO TX
78229-6306
US

IV. Provider business mailing address

4410 MEDICAL DR STE 610
SAN ANTONIO TX
78229-6306
US

V. Phone/Fax

Practice location:
  • Phone: 210-614-2453
  • Fax: 210-614-4457
Mailing address:
  • Phone: 210-614-2453
  • Fax: 210-614-4457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberH7313
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: