MEDICARE: DALLAS BROADWAY M.D.

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	261QA1903X	Ambulatory Surgical Clinic/Center	249640	NY
2	261QA1903X	Ambulatory Surgical Clinic/Center	25MA09187400	NJ
3	2085R0204X	Vascular & Interventional Radiology Physician	P8223	TX

General Provider Information

NPI Number	:	1366646416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALLAS BROADWAY M.D.

Provider Business Mailing Address
First Line	:	1010 NW LOOP 410 STE 100B
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-2220
Country	:	US
Telephone Number	:	210-465-7015
Fax Number	:	210-465-7014

Provider Business Practice Location Address
First Line	:	1010 NW LOOP 410 STE 100B
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-2220
Country	:	US
Telephone Number	:	210-465-7015
Fax Number	:	210-465-7014

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

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	11/03/2021

Similar Medicare Providers

1881914000 — GRUPO MEDICO POLICLINICA SAN PEDRO MEDICARE ADVANTAGE
Practice Location Address:

211 CALLE MORSE
ARROYO, PR
00714-2350

Practice Phone: 787-839-3980
Practice Fax: 787-271-2515

1750382503 — DR. ROGER M MOCZYGEMBA MD
Practice Location Address:

1010 NW LOOP 410 STE 100A
SAN ANTONIO, TX
78213-2220

Practice Phone: 210-886-8031
Practice Fax: 210-886-8059

1992769137 — DR. SURESH V DUTTA M.D.
Practice Location Address:

1010 NW LOOP 410 , SUITE 100D
SAN ANTONIO, TX
78213-2220

Practice Phone: 210-308-9999
Practice Fax: 210-308-6262

1023057528 — BEVERLY SPAULDING GUTIERREZ M.D.
Practice Location Address:

1010 NW LOOP 410 STE 100A
SAN ANTONIO, TX
78213-2220

Practice Phone: 210-886-8031
Practice Fax: 210-886-8059

1447486717 — MEDICINE & RADIATION ONCOLOGY, PA
Practice Location Address:

1010 NW LOOP 410 , SUITE 100-D
SAN ANTONIO, TX
78213-2220

Practice Phone: 210-308-9999
Practice Fax: 210-308-6262

1053642983 — SA EXPERT PHYSICIANS PLLC
Practice Location Address:

1010 NW LOOP 410
SAN ANTONIO, TX
78213-2220

Practice Phone: 281-404-3024
Practice Fax: 281-520-4221

Directions to “ DALLAS BROADWAY M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.