Basic Information
| Provider Information | |||||||||
| NPI: | 1255514790 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JOE PENDON MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2405 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782982405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105586288 | ||||||||
| FaxNumber: | 2105586289 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 N SAN SABA | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782073154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2107044300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2007 | ||||||||
| LastUpdateDate: | 12/26/2008 | ||||||||
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| AuthorizedOfficialLastName: | PENDON | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2105586288 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0005X | M2012 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Undersea and Hyperbaric Medicine |
No ID Information.