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General NPI Number Information
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NPI Number | 1609132992
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Entity Type | Organization
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Legal Business Name | DRO MD, PA
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Dates
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Enumeration Date | 04/11/2012
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Last Update Date | 01/13/2015
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Provider Practice Location Address
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Address Line | 1202 E SONTERRA BLVD SUITE 302
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City | SAN ANTONIO
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State | TX
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Zip | 78258
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Country | US
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Telephone | 210-853-2790
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Fax | 210-314-6293
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Provider Business Mailing Address
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Address Line | 1202 E SONTERRA BLVD SUITE 302
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City | SAN ANTONIO
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State | TX
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Zip | 78258
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Country | US
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Telephone | 210-853-2790
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Fax | 210-314-6293
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Authorized Official
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Title or Position | PHYSICIAN
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Name | TINUADE OLUSEGUN-GBADEHAN
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Credential | M.D.
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Telephone | 210-853-2790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | N3663
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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