MEDICARE: PVD MEDICAL ASSOCIATES, PLLC

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	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1396118147
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PVD MEDICAL ASSOCIATES, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 690804
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78269-0804
Country	:	US
Telephone Number	:	210-564-9790
Fax Number	:	210-564-9741

Provider Business Practice Location Address
First Line	:	18007 IH 10 W
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-9536
Country	:	US
Telephone Number	:	210-530-1040
Fax Number	:	210-530-1187

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PETER VAN DELDEN
Credential	:	MD
Telephone Number	:	210-445-4450

Provider Enumeration Date	:	11/02/2015
Last Update Date	:	05/29/2024

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