Healthcare Provider Details

I. General information

NPI: 1093946188
Provider Name (Legal Business Name): FERMIN BRIONES JR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 05/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4242 MEDICAL DRIVE STE 6300
SAN ANTONIO TX
78229-5640
US

IV. Provider business mailing address

4242 MEDICAL DRIVE STE 6300
SAN ANTONIO TX
78229-5640
US

V. Phone/Fax

Practice location:
  • Phone: 210-614-8400
  • Fax:
Mailing address:
  • Phone: 210-614-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberN0660
License Number StateTX

VIII. Authorized Official

Name: DR. FERMIN BRIONES JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 210-872-8060