MEDICARE: MR. GIL J CERROS

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	1710I1002X	Independent Duty Corpsman	1710L1002X	TN

General Provider Information

NPI Number	:	1801864616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GIL J CERROS

Provider Business Mailing Address
First Line	:	25850 BIG BLUESTEM
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78261
Country	:	US
Telephone Number	:	405-822-4471
Fax Number	:

Provider Business Practice Location Address
First Line	:	25850 BIG BLUESTEM
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78261
Country	:	US
Telephone Number	:	405-822-4471
Fax Number	:

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	06/12/2014

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