Organization
DIABETES AND GLANDULAR DISEASE CLINIC CERTIFIED DIABETES EDUCATION CEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH BAGWELL MT (DIRECTOR OF CLINIC OPERATIONS)
(210) 615-5541
Entity
Organization
Contact information
Practice address
5107 MEDICAL DR, SAN ANTONIO, TX 78229-4801
(210) 614-8612
(210) 615-1666
Mailing address
5107 MEDICAL DR, SAN ANTONIO, TX 78229-4801
(210) 614-8612
(210) 615-1666
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121762202
—
TX
Enumeration date
03/02/2010
Last updated
08/24/2023
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