Healthcare Provider Details

I. General information

NPI: 1265858492
Provider Name (Legal Business Name): ANWAR S GERGES MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19234 STONEHUE
SAN ANTONIO TX
78258-3477
US

IV. Provider business mailing address

19234 STONEHUE
SAN ANTONIO TX
78258-3477
US

V. Phone/Fax

Practice location:
  • Phone: 210-481-9544
  • Fax: 210-481-9545
Mailing address:
  • Phone: 210-481-9544
  • Fax: 210-481-9545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberK2111
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberM8988
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberJ5769
License Number StateTX

VIII. Authorized Official

Name: RANDY RAMON
Title or Position: ADMINISTRATOR
Credential:
Phone: 210-481-9544