MEDICARE: EARS OF TEXAS, P.A.

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	174400000X	Specialist	E4463	TX

General Provider Information

NPI Number	:	1043498470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EARS OF TEXAS, P.A.

Provider Business Mailing Address
First Line	:	2632 BROADWAY ST
Second Line	:	SUITE 201-202
City	:	SAN ANTONIO
State	:	TX
Zip	:	78215-1137
Country	:	US
Telephone Number	:	210-697-0880
Fax Number	:	210-697-0888

Provider Business Practice Location Address
First Line	:	2632 BROADWAY ST
Second Line	:	SUITE 201-202
City	:	SAN ANTONIO
State	:	TX
Zip	:	78215-1137
Country	:	US
Telephone Number	:	210-697-0880
Fax Number	:	210-697-0888

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	WESLEY W.O. KRUEGER
Credential	:	M.D.
Telephone Number	:	210-697-0880

Provider Enumeration Date	:	02/07/2008
Last Update Date	:	02/07/2008

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Directions to “EARS OF TEXAS, P.A. ” Practice Location

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