MEDICARE: ANTHONY THOMAS STAVROS M.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	2085R0202X	Diagnostic Radiology Physician	18255	CO
2	2085R0202X	Diagnostic Radiology Physician	Q2069	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	300090435	OTHER	CO	RR RIA MCRE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	300090433	OTHER	CO	RR DIA MCRE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	300048672	OTHER	CO	RR MIC MCRE
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982658381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY THOMAS STAVROS M.D.

Provider Business Mailing Address
First Line	:	5253 PRUE RD
Second Line	:	SUITE 315, BUILDING 3
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1758
Country	:	US
Telephone Number	:	707-849-6548
Fax Number	:

Provider Business Practice Location Address
First Line	:	5253 PRUE RD
Second Line	:	SUITE 315, BUILDING 3
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1758
Country	:	US
Telephone Number	:	707-849-6548
Fax Number	:

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

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	04/29/2015

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