Individual
GERARDO QUEZADA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4410 MEDICAL DR, SUITE 540, SAN ANTONIO, TX 78229-3749
(210) 575-6240
(210) 575-6280
Mailing address
8109 FREDERICKSBURG RD, PHYSICIAN PRACTICE SERVICES, SAN ANTONIO, TX 78229-3311
(210) 575-6240
(210) 575-6280
Taxonomy
Speciality
Code
Description
License number
State
207RH0000X
Hematology (Internal Medicine) Physician
M7544
TX
208000000X
Pediatrics Physician
M7544
TX
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
M7544
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
191616505
—
TX
01
—
191616506
CSHCN
TX
01
—
8BX396
BCBS TX
—
01
—
8F10114
MEDICARE
TX
Enumeration date
02/21/2008
Last updated
03/09/2012
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