Healthcare Provider Details

I. General information

NPI: 1124246103
Provider Name (Legal Business Name): TEXAS ASSOCIATION OF PEDIATRIC NEUROLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 OAK CENTRE DR SUITE #400
SAN ANTONIO TX
78258-3944
US

IV. Provider business mailing address

PO BOX 34713
SAN ANTONIO TX
78265-4713
US

V. Phone/Fax

Practice location:
  • Phone: 210-615-2333
  • Fax: 210-490-5024
Mailing address:
  • Phone: 210-615-2333
  • Fax: 210-490-5024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License NumberG7730
License Number StateTX

VIII. Authorized Official

Name: DR. JERRY J TOMASOVIC
Title or Position: OWNER
Credential: MD
Phone: 210-615-2333