MEDICARE: DR. THOMAS MIERAS 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	207R00000X	Internal Medicine Physician	H4555	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1285684225	OTHER		GROUP NPI

General Provider Information

NPI Number	:	1578564787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS MIERAS MD

Provider Business Mailing Address
First Line	:	8401 DATAPOINT DR
Second Line	:	#401
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-5900
Country	:	US
Telephone Number	:	210-949-2203
Fax Number	:	210-614-2186

Provider Business Practice Location Address
First Line	:	2829 BABCOCK RD STE 500
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-6028
Country	:	US
Telephone Number	:	210-705-5600
Fax Number	:	210-692-1829

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	02/07/2024

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