Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | H5866 | TX |
NPI | 1013986629 |
---|---|
Provider Name | Dr. Alex De Jesus |
First Address | San Antonio, TX 78229-3430 |
Second Address | San Antonio, TX 78229-3430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 16/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
134972210 | (05) | TX |