Individual
IDA JUAREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4330 MEDICAL DR, STE 500, SAN ANTONIO, TX 78229-3342
(210) 576-5306
(210) 694-0645
Mailing address
4330 MEDICAL DR, STE 500, SAN ANTONIO, TX 78229-3342
(210) 576-5306
(210) 694-0645
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
N5137
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TXB145184
WELLMED MEDICAL GROUP PA
TX
01
—
TXB156606
WELLMED NETWORKS INC
TX
Enumeration date
07/18/2007
Last updated
07/15/2015
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