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General NPI Number Information
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NPI Number | 1750329140
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Entity Type | Individual
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Provider Name | JEROME DOUGLAS KIZZART MD
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Gender | Male
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 11/29/2014
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Provider Practice Location Address
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Address Line | 1004 S SAINT MARYS ST
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City | SAN ANTONIO
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State | TX
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Zip | 78205-3413
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Country | US
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Telephone | 830-299-4040
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Fax | 281-826-2598
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Provider Business Mailing Address
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Address Line | 923 10TH ST SUITE 101
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City | FLORESVILLE
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State | TX
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Zip | 78114-1851
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Country | US
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Telephone | 830-299-4040
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Fax | 281-826-2598
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | H3823
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207PE0005X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
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License Number | H3823
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | H3823
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | H3823
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License Number State | TX
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