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General NPI Number Information
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NPI Number | 1912946427
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Entity Type | Organization
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Legal Business Name | SOUTH SAN ANTONIO MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2207 S ZARZAMORA ST
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City | SAN ANTONIO
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State | TX
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Zip | 78207-8005
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Country | US
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Telephone | 210-223-3863
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Fax | 210-224-6305
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Provider Business Mailing Address
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Address Line | 11765 WEST AVEUNE PMB 192
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City | SAN ANTONIO
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State | TX
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Zip | 78216
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Country | US
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Telephone | 210-924-7158
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Fax | 210-924-4642
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RONALD D WONG
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Credential | M.D.
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Telephone | 210-924-7158
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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 | J5950
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License Number State | TX
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