Organization
ALEXIS WIESENTHAL MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALEXIS WIESENTHAL M.D. (PRESIDENT)
(210) 857-3767
Entity
Organization
Contact information
Practice address
8038 WURZBACH RD STE 320, SAN ANTONIO, TX 78229-3813
(210) 614-3365
Mailing address
PO BOX 6627, SAN ANTONIO, TX 78209-0627
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
N1219
TX
261QP2300X
Primary Care Clinic/Center
Primary
N1219
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8F9634
MEDICARE PTAN
TX
Enumeration date
05/16/2012
Last updated
05/16/2012
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