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General NPI Number Information
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NPI Number | 1699163923
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Entity Type | Organization
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Legal Business Name | PRIMWAY MEDICAL, PLLC
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Dates
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Enumeration Date | 01/09/2015
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Last Update Date | 12/23/2015
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Provider Practice Location Address
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Address Line | 11345 ALAMO RANCH PKWY SUITE 202
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City | SAN ANTONIO
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State | TX
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Zip | 78253-6440
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Country | US
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Telephone | 210-688-9190
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Fax | 877-936-8202
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Provider Business Mailing Address
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Address Line | 11345 ALAMO RANCH PKWY STE. 202
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City | SAN ANTONIO
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State | TX
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Zip | 78253-6440
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Country | US
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Telephone | 210-688-9190
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Fax | 877-936-8202
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | MR. ADENIYI O IGUN
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Credential | M.D.
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Telephone | 210-688-9190
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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 |
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License Number State |
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