Healthcare Provider Details

I. General information

NPI: 1225807530
Provider Name (Legal Business Name): PREMIER OB-GYN OF TEXAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4458 MEDICAL DR STE 450
SAN ANTONIO TX
78229-3700
US

IV. Provider business mailing address

4458 MEDICAL DR STE 450
SAN ANTONIO TX
78229-3700
US

V. Phone/Fax

Practice location:
  • Phone: 210-440-4149
  • Fax: 210-615-1236
Mailing address:
  • Phone: 210-440-4149
  • Fax: 210-615-1236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSE M RUIZ
Title or Position: MD
Credential:
Phone: 210-440-4149