Healthcare Provider Details

I. General information

NPI: 1306967658
Provider Name (Legal Business Name): LONE STAR PRIMARY CARE AND AESTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3619 PAESANOS PARKWAY SUITE 206
SAN ANTONIO TX
78231-1255
US

IV. Provider business mailing address

3619 PAESANOS PARKWAY SUITE 206
SAN ANTONIO TX
78231-1255
US

V. Phone/Fax

Practice location:
  • Phone: 210-298-7827
  • Fax: 210-298-7888
Mailing address:
  • Phone: 210-298-7827
  • Fax: 210-298-7888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNEFER C SUTTON
Title or Position: PHYSICIAN PARTNER
Credential: M.D.
Phone: 210-298-7827