MEDICARE: SOUTH SAN ANTONIO MEDICAL ASSOCIATES

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	J5950	TX

General Provider Information

NPI Number	:	1912946427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH SAN ANTONIO MEDICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	11765 WEST AVEUNE
Second Line	:	PMB 192
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216
Country	:	US
Telephone Number	:	210-924-7158
Fax Number	:	210-924-4642

Provider Business Practice Location Address
First Line	:	2207 S ZARZAMORA ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-8005
Country	:	US
Telephone Number	:	210-223-3863
Fax Number	:	210-224-6305

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RONALD D WONG
Credential	:	M.D.
Telephone Number	:	210-924-7158

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	08/22/2020

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