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General NPI Number Information
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NPI Number | 1609380146
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Entity Type | Organization
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Legal Business Name | MID TEXAS INFECTIOUS DISEASES CONSULTANTS PA
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Dates
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Enumeration Date | 11/20/2017
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Last Update Date | 11/20/2017
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Provider Practice Location Address
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Address Line | 8715 VILLAGE DR STE 116
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City | SAN ANTONIO
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State | TX
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Zip | 78217-5407
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Country | US
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Telephone | 210-215-2751
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Fax |
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Provider Business Mailing Address
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Address Line | 114 AYLESBURY HILL ST
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City | SAN ANTONIO
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State | TX
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Zip | 78209-5442
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Country | US
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Telephone | 210-844-1687
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | PETER JOHN DEWITT
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Credential |
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Telephone | 210-844-1687
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | K2151
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License Number State | TX
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