Organization
MEDICAL TECHNOLOGY PROVIDER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DMITRIY BUYANOV M.D. (PRESIDENT)
(210) 298-6630
Entity
Organization
Contact information
Practice address
2425 BABCOCK RD, STE. 102, SAN ANTONIO, TX 78229-4898
(210) 298-6630
Mailing address
2425 BABCOCK RD, STE. 102, SAN ANTONIO, TX 78229-4898
(210) 298-6630
Taxonomy
Speciality
Code
Description
License number
State
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
Primary
—
—
Other
Enumeration date
03/31/2015
Last updated
03/31/2015
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