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General NPI Number Information
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NPI Number | 1457384158
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Entity Type | Organization
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Legal Business Name | JAIME L MAYORAL MD PA
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 04/03/2009
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Provider Practice Location Address
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Address Line | 315 N SAN SABA SUITE 1240
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City | SAN ANTONIO
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State | TX
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Zip | 78207-3154
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Country | US
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Telephone | 210-212-4114
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Fax | 210-212-4012
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Provider Business Mailing Address
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Address Line | PO BOX 596
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City | SAN ANTONIO
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State | TX
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Zip | 78292-0596
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Country | US
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Telephone | 210-212-4114
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Fax | 210-212-4012
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAIME L MAYORAL
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Credential | MD
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Telephone | 210-212-4114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | J9199
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | J9199
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License Number State | TX
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