Individual
GREGORY COLEMAN IGLESIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1301 WONDER WORLD DR, SAN MARCOS, TX 78666-7533
(512) 396-8565
(512) 396-8567
Mailing address
PO BOX 1005, SAN MARCOS, TX 78667-1005
(512) 396-8565
(512) 396-8567
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
H7991
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00TS99
BCBSSTX
TX
05
—
103672502
—
TX
01
—
880858Z
BCBSTX
TX
Enumeration date
07/21/2005
Last updated
07/11/2008
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