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NPI Code Detail

MEDICARE: DECO DISTRICT DOCTORS OFFICE LLC

MEDICARE: DECO DISTRICT DOCTORS OFFICE LLC
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
1207Q00000XFamily Medicine PhysicianH9604TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10069KDOTHERTXBLUE CROSS GROUP

General Provider Information

NPI Number : 1568688752
Entity Type Code : Organization
Provider Name (Legal Business Name) : DECO DISTRICT DOCTORS OFFICE LLC
Provider Business Mailing Address
First Line : 3202 SAN PEDRO AVE
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78212-2247
Country : US
Telephone Number : 210-732-5100
Fax Number : 210-732-5108
Provider Business Practice Location Address
First Line : 3202 SAN PEDRO AVE
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78212-2247
Country : US
Telephone Number : 210-732-5100
Fax Number : 210-732-5108
Authorized Official
Title or Position : OWNER
Name : JAMES M BROMLEY
Credential : M.D.
Telephone Number : 210-732-5100
Provider Enumeration Date : 04/17/2007
Last Update Date : 12/17/2009

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Directions to “DECO DISTRICT DOCTORS OFFICE LLC ” Practice Location

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