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General NPI Number Information
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NPI Number | 1467578971
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Entity Type | Organization
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Legal Business Name | GUSTAVO J MEDELLIN MD PA
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 11/06/2020
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Provider Practice Location Address
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Address Line | 7700 FLOYD CURL DR
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3902
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Country | US
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Telephone | 210-575-4000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1158
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City | SAN ANTONIO
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State | TX
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Zip | 78294-1158
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Country | US
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Telephone | 210-558-6288
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Fax | 210-558-6289
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Authorized Official
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Title or Position | PRESIDENT
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Name | GUSTAVO JAVIER MEDELLIN
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Credential | MD
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Telephone | 210-558-6288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | K0129
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License Number State | TX
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