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General NPI Number Information
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NPI Number | 1518394485
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Entity Type | Organization
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Legal Business Name | MALE MEDICAL GROUP MANAGEMENT, LLC
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Dates
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Enumeration Date | 10/08/2013
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Last Update Date | 10/08/2013
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Provider Practice Location Address
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Address Line | 14615 SAN PEDRO AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78232-4321
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Country | US
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Telephone | 210-263-9878
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Fax | 210-855-8382
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Provider Business Mailing Address
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Address Line | 14615 SAN PEDRO AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78232-4321
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Country | US
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Telephone | 210-263-9878
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Fax | 210-855-8382
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRANDON HEATH
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Credential |
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Telephone | 210-263-9878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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