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General NPI Number Information
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NPI Number | 1508054842
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Entity Type | Organization
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Legal Business Name | WEST KIRK MEDICAL PRACTICE, PA
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Dates
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Enumeration Date | 10/11/2007
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Last Update Date | 09/16/2014
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Provider Practice Location Address
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Address Line | 711 KIRK PL
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City | SAN ANTONIO
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State | TX
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Zip | 78226-1416
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Country | US
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Telephone | 210-227-9408
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Fax |
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Provider Business Mailing Address
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Address Line | 711 KIRK PL
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City | SAN ANTONIO
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State | TX
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Zip | 78226-1416
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Country | US
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Telephone | 210-227-9408
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Fax |
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Authorized Official
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Title or Position | M.D.
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Name | LEONEL TANO
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Credential |
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Telephone | 210-227-9408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | E7516
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License Number State | TX
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