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General NPI Number Information
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NPI Number | 1104043504
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Entity Type | Organization
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Legal Business Name | RADIOLOGY ASSOCIATES OF SAN MARCOS
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 1301 WONDER WORLD DR
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City | SAN MARCOS
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State | TX
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Zip | 78666-7533
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Country | US
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Telephone | 512-396-8565
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1005
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City | SAN MARCOS
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State | TX
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Zip | 78667-1005
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Country | US
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Telephone | 512-396-8565
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GREG IGLESIA
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Credential | MD
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Telephone | 512-396-8565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | H7991
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License Number State | TX
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