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General NPI Number Information
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NPI Number | 1427183987
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Entity Type | Organization
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Legal Business Name | SOUTH TEXAS MEDICAL CENTER
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2506 S LANCASTER RD
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City | DALLAS
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State | TX
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Zip | 75216-2532
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Country | US
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Telephone | 214-374-2880
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Fax | 214-374-2853
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Provider Business Mailing Address
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Address Line | 2506 S LANCASTER RD
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City | DALLAS
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State | TX
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Zip | 75216-2532
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Country | US
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Telephone | 214-374-2880
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Fax | 214-374-2853
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JILL WAGGONER
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Credential | M.D.
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Telephone | 214-374-2880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | J4593
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License Number State | TX
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