Healthcare Provider Details

I. General information

NPI: 1427373562
Provider Name (Legal Business Name): MICHAEL THOMAS SHOFFEITT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 12/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 MEDICAL DR
SAN ANTONIO TX
78229-4402
US

IV. Provider business mailing address

7703 FLOYD CURL DR # 7982
SAN ANTONIO TX
78229-3901
US

V. Phone/Fax

Practice location:
  • Phone: 210-743-6023
  • Fax: 210-358-0647
Mailing address:
  • Phone: 210-743-6023
  • Fax: 210-358-0647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberP7209
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: