Basic Information
| Provider Information | |||||||||
| NPI: | 1366767493 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAVEZ | ||||||||
| FirstName: | ANTONIO | ||||||||
| MiddleName: | B. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8711 VILLAGE DR STE 114 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782175419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102267827 | ||||||||
| FaxNumber: | 2106105706 | ||||||||
| Practice Location | |||||||||
| Address1: | 7940 FLOYD CURL DR STE 900 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102267827 | ||||||||
| FaxNumber: | 2104336329 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2010 | ||||||||
| LastUpdateDate: | 07/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Q1111 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 344028103 | 05 | TX | MEDICAID |