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General NPI Number Information
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NPI Number | 1245720911
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Entity Type | Organization
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Legal Business Name | GREATER MEDICAL MISSION GROUP PLLC
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Dates
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Enumeration Date | 05/17/2018
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Last Update Date | 06/13/2018
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Provider Practice Location Address
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Address Line | 426 CASTROVILLE RD STE 3
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City | SAN ANTONIO
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State | TX
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Zip | 78207
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Country | US
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Telephone | 877-664-7201
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Fax | 800-218-7489
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Provider Business Mailing Address
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Address Line | 11631 CAMP REAL LN
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City | SAN ANTONIO
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State | TX
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Zip | 78253-6331
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Country | US
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Telephone | 210-908-9358
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Fax | 210-239-5921
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | UGHWANMWAN T EFEOVBOKHAN
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Credential | GNP-BC
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Telephone | 210-908-9358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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