Healthcare Provider Details

I. General information

NPI: 1962638833
Provider Name (Legal Business Name): PEDIATRIC INFECTIOUS DISEASES ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2009
Last Update Date: 06/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7922 EWING HALSELL DR SUITE 270
SAN ANTONIO TX
78229-3786
US

IV. Provider business mailing address

7922 EWING HALSELL DR SUITE 270
SAN ANTONIO TX
78229-3786
US

V. Phone/Fax

Practice location:
  • Phone: 210-614-2828
  • Fax: 210-614-2558
Mailing address:
  • Phone: 210-614-2828
  • Fax: 210-614-2558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberJ3733
License Number StateTX

VIII. Authorized Official

Name: DR. JANE T ATKINS
Title or Position: MD
Credential: MD
Phone: 210-614-2828