Healthcare Provider Details

I. General information

NPI: 1790033512
Provider Name (Legal Business Name): GERARDO E. CARCAMO, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 NAVARRO ST SUITE 810
SAN ANTONIO TX
78205-2577
US

IV. Provider business mailing address

414 NAVARRO ST SUITE 810
SAN ANTONIO TX
78205-2577
US

V. Phone/Fax

Practice location:
  • Phone: 210-220-1726
  • Fax: 210-224-3058
Mailing address:
  • Phone: 210-220-1726
  • Fax: 210-224-3058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberK4014
License Number StateTX

VIII. Authorized Official

Name: DR. GERARDO E CARCAOM
Title or Position: M.D., PRESIDENT
Credential: M.D.
Phone: 210-220-1726