Healthcare Provider Details

I. General information

NPI: 1699098400
Provider Name (Legal Business Name): DEERWOOD FAMILY PRACTICE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4358 LOCKHILL SELMA RD STE 110
SAN ANTONIO TX
78249
US

IV. Provider business mailing address

4358 LOCKHILL SELMA RD STE 110
SAN ANTONIO TX
78249-4167
US

V. Phone/Fax

Practice location:
  • Phone: 210-492-4300
  • Fax: 210-492-4380
Mailing address:
  • Phone: 210-492-4300
  • Fax: 210-492-4380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DENISE GARZA
Title or Position: BILLING MANAGER
Credential:
Phone: 210-595-6696