Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | M7544 | TX |
N | 208000000X | Pediatrician | M7544 | TX |
Y | 2080P0207X | Pediatric Hematology-Oncologist | M7544 | TX |
NPI | 1427227602 |
---|---|
Provider Name | Gerardo Quezada |
First Address | San Antonio, TX 78229-3311 |
Second Address | San Antonio, TX 78229-3749 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2008 |
Last Update Date | 09/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
191616505 | (05) | TX |
191616506 | CSHCN (01) | TX |
8BX396 | BCBS TX (01) | |
8F10114 | MEDICARE (01) | TX |