Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | D2390 | TX |
N | 207QG0300X | Family Doctor - Geriatric Medicine | D2390 | TX |
NPI | 1336180439 |
---|---|
Provider Name | Dr. Antonio Cavazos JR. |
First Address | San Antonio, TX 78229-5705 |
Second Address | San Antonio, TX 78229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 31/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C14313 | (02) | TX |