MEDICARE: CHARLES P BIEDIGER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	J3991	TX

General Provider Information

NPI Number	:	1033127022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES P BIEDIGER MD

Provider Business Mailing Address
First Line	:	PO BOX 2679
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78299-2679
Country	:	US
Telephone Number	:	210-616-0096
Fax Number	:	210-614-1003

Provider Business Practice Location Address
First Line	:	19026 STONE OAK PKWY
Second Line	:	SUITE 110
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3227
Country	:	US
Telephone Number	:	210-545-0404
Fax Number	:	210-614-1003

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	07/08/2007

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Directions to “ CHARLES P BIEDIGER MD” Practice Location

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