Organization
PRO PHYSICIANS CLINIC, PA
Active
Parent organization
PRO PHYSICIANS CLINIC, PA
Other names
Pro Physicians Clinic, PA
Organization subpart
Yes
Provider details
NPI number
Legal business name
PRO PHYSICIANS CLINIC, PA
Authorized official
JON D TRYGGESTAD (CEO)
(817) 886-8730
Entity
Organization
Contact information
Practice address
12705 TOEPPERWEIN RD, LIVE OAK, TX 78233-3257
(210) 816-4770
(210) 816-4771
Mailing address
8019 S NEW BRAUNFELS STE 101, SAN ANTONIO, TX 78235-1069
(210) 816-4770
(210) 816-4771
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0A3406
MEDICARE PTAN
TX
Enumeration date
07/27/2009
Last updated
02/25/2019
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