Organization
PLASTIC SURGERY OF NORTHEAST SAN ANTONIO
Active
Parent organization
KENZER J DIRKSON MD
Organization subpart
Yes
Provider details
NPI number
Legal business name
KENZER J DIRKSON MD
Authorized official
MRS. MARY E FLORES (DR.'S ASSISTANT/ BILLING PERSONEL)
(210) 656-4216
Entity
Organization
Contact information
Practice address
19315 NACOGDOCHES RD, STE. 305, SAN ANTONIO, TX 78266-2516
(210) 656-4216
(210) 656-4217
Mailing address
19315 NACOGDOCHES RD, STE. 305, SAN ANTONIO, TX 78266-2516
(210) 656-4216
(210) 656-4217
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
K7278
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127561201
—
TX
Enumeration date
08/12/2010
Last updated
08/12/2010
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