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General NPI Number Information
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NPI Number | 1467824540
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Entity Type | Organization
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Legal Business Name | PBVDM-HUEBNER, LLC
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Dates
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Enumeration Date | 10/28/2015
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Last Update Date | 10/28/2015
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Provider Practice Location Address
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Address Line | 16403 HUEBNER RD
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City | SAN ANTONIO
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State | TX
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Zip | 78248-1683
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Country | US
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Telephone | 210-564-9790
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Fax | 210-564-9741
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Provider Business Mailing Address
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Address Line | 16403 HUEBNER RD
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City | SAN ANTONIO
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State | TX
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Zip | 78248-1683
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Country | US
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Telephone | 210-564-9790
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Fax | 210-564-9741
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PETER VAN DELDEN
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Credential | MD
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Telephone | 210-445-4450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number |
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License Number State | TX
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