Healthcare Provider Details

I. General information

NPI: 1457579153
Provider Name (Legal Business Name): NEUROLOGY MEDICAL CONSULTANTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 NAVARRO ST STE 909
SAN ANTONIO TX
78205-2516
US

IV. Provider business mailing address

PO BOX 1494
SAN ANTONIO TX
78295-1494
US

V. Phone/Fax

Practice location:
  • Phone: 210-579-3208
  • Fax: 210-579-3279
Mailing address:
  • Phone: 210-733-0578
  • Fax: 210-587-8549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberK8037
License Number StateTX

VIII. Authorized Official

Name: DR. NANCY A BURT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 210-579-3208