MEDICARE: DR. JAMES KORETZ PH.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	103TC0700X	Clinical Psychologist	23410	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	134797	OTHER	TX	VALUEOPTIONS INSURANCE
2	A85L	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1770631855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES KORETZ PH.D.

Provider Business Mailing Address
First Line	:	12915 JONES MALTSBERGER RD
Second Line	:	SUITE 600
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-4282
Country	:	US
Telephone Number	:	210-805-0513
Fax Number	:	210-641-9634

Provider Business Practice Location Address
First Line	:	12915 JONES MALTSBERGER RD
Second Line	:	SUITE 600
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-4282
Country	:	US
Telephone Number	:	210-805-0513
Fax Number	:	210-641-9634

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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