=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932326014
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHWEST PAIN & INJURY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12770 CIMARRON PATH STE 116
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78249-3415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-826-2262
-----------------------------------------------------
Fax | 210-509-4813
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12770 CIMARRON PATH STE 116
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78249-3415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-826-2262
-----------------------------------------------------
Fax | 210-509-4813
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. EDDIE LEON CERDAY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 210-826-2262
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MDF9289TX
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------