MEDICARE: GERALDO M SIOCO 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	207RC0000X	Cardiovascular Disease Physician	J2337	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0015GN	OTHER	TX	BCBS GROUP
3	8B0460	OTHER	TX	BCBS TX

General Provider Information

NPI Number	:	1255398699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALDO M SIOCO MD

Provider Business Mailing Address
First Line	:	1545 BENTON WOODS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4494
Country	:	US
Telephone Number	:	210-408-6792
Fax Number	:

Provider Business Practice Location Address
First Line	:	9465 HUEBNER RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1508
Country	:	US
Telephone Number	:	210-614-8800
Fax Number	:	210-614-8880

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

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	09/30/2010

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Directions to “ GERALDO M SIOCO MD” Practice Location

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