Organization
UROLOGY ASSOC OF SAN ANTONIO PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY ELLIOT KRUSE MD (PRESIDENT)
(210) 227-9376
Entity
Organization
Contact information
Practice address
1303 MCCULLOUGH AVE, SUITE 561, SAN ANTONIO, TX 78212-5668
(210) 227-9376
(210) 227-0916
Mailing address
1303 MCCULLOUGH AVE, SUITE 561, SAN ANTONIO, TX 78212-5668
(210) 227-9376
(210) 227-0916
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
083200801
—
TX
01
—
CP8906
RAILROAD MEDICARE
TX
Enumeration date
09/12/2006
Last updated
07/06/2010
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