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General NPI Number Information
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NPI Number | 1316268717
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Entity Type | Individual
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Provider Name | ANDREW JATSKIV M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/20/2010
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Last Update Date | 07/03/2018
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Provider Practice Location Address
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Address Line | 4502 MEDICAL DR
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City | SAN ANTONIO
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State | TX
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Zip | 78229
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Country | US
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Telephone | 210-358-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 8811 VILLAGE DR
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City | SAN ANTONIO
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State | TX
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Zip | 78217-5415
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Country | US
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Telephone | 210-297-6500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | P7472
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License Number State | TX
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