Individual
DR. JEROME TILLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
108 WAYDELE CIRCLE, SAN ANTONIO, TX 78213
(210) 341-9560
Mailing address
108 WAYDELE CIR, SAN ANTONIO, TX 78213-3345
(210) 341-9560
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
E0170
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140030103
—
TX
01
—
87130S
BLUECROSS AND BLUESHIELD
TX
Enumeration date
12/02/2005
Last updated
07/08/2007
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