Healthcare Provider Details

I. General information

NPI: 1215113642
Provider Name (Legal Business Name): LONE STAR PM & R GROUP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 VILLAGE DR STE 204
SAN ANTONIO TX
78217-5510
US

IV. Provider business mailing address

8601 VILLAGE DRIVE, STE 118
SAN ANTONIO TX
78205-5509
US

V. Phone/Fax

Practice location:
  • Phone: 210-222-2606
  • Fax: 210-222-8410
Mailing address:
  • Phone: 210-222-2606
  • Fax: 210-222-8410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberJ8327
License Number StateTX

VIII. Authorized Official

Name: PATRICK MULROY
Title or Position: PHYSICIAN/PRESIDENT
Credential: MD
Phone: 210-616-9990