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General NPI Number Information
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NPI Number | 1366470353
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Entity Type | Individual
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Provider Name | WESLEY K GREYDANUS M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 07/17/2009
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Provider Practice Location Address
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Address Line | 16607 BLANCO RD SUITE #603
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City | SAN ANTONIO
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State | TX
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Zip | 78232-1941
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Country | US
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Telephone | 210-485-1850
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Fax | 210-493-9500
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Provider Business Mailing Address
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Address Line | PO BOX 2408
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City | SAN ANTONIO
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State | TX
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Zip | 78298-2408
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Country | US
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Telephone | 210-485-1850
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Fax | 210-493-9500
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD00024790
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License Number State | WA
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