=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437328481
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DCOA PHYSICIAN ASSOCIATES PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2008
-----------------------------------------------------
Last Update Date | 02/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3154 SE MILITARY DR SUITE 103
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78223-3974
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-237-3500
-----------------------------------------------------
Fax | 832-237-0200
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 RIVERWAY SUITE 825
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77056-1919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-840-5245
-----------------------------------------------------
Fax | 281-897-9906
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | MIKE RZENDZIAN
-----------------------------------------------------
Credential | CFO
-----------------------------------------------------
Telephone | 832-237-3500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------