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General NPI Number Information
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NPI Number | 1568688752
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Entity Type | Organization
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Legal Business Name | DECO DISTRICT DOCTORS OFFICE LLC
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 12/17/2009
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Provider Practice Location Address
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Address Line | 3202 SAN PEDRO AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78212-2247
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Country | US
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Telephone | 210-732-5100
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Fax | 210-732-5108
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Provider Business Mailing Address
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Address Line | 3202 SAN PEDRO AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78212-2247
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Country | US
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Telephone | 210-732-5100
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Fax | 210-732-5108
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Authorized Official
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Title or Position | OWNER
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Name | JAMES M BROMLEY
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Credential | M.D.
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Telephone | 210-732-5100
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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 | H9604
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License Number State | TX
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