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General NPI Number Information
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NPI Number | 1760485098
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Entity Type | Individual
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Provider Name | TERENCE F FAVAZZA M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 12709 TOEPPERWEIN RD STE 206
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City | LIVE OAK
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State | TX
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Zip | 78233-3260
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Country | US
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Telephone | 210-564-8000
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Fax | 210-679-3732
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Provider Business Mailing Address
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Address Line | 7909 FREDERICKSBURG RD STE 110
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3400
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Country | US
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Telephone | 210-614-4544
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Fax | 210-679-3724
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | S5614
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License Number State | TX
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