Healthcare Provider Details

I. General information

NPI: 1104043504
Provider Name (Legal Business Name): RADIOLOGY ASSOCIATES OF SAN MARCOS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 WONDER WORLD DR
SAN MARCOS TX
78666-7533
US

IV. Provider business mailing address

PO BOX 1005
SAN MARCOS TX
78667-1005
US

V. Phone/Fax

Practice location:
  • Phone: 512-396-8565
  • Fax:
Mailing address:
  • Phone: 512-396-8565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberH7991
License Number StateTX

VIII. Authorized Official

Name: GREG IGLESIA
Title or Position: PRESIDENT
Credential: MD
Phone: 512-396-8565