Basic Information
| Provider Information | |||||||||
| NPI: | 1659701845 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UROLOGY SAN ANTONIO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7909 FREDERICKSBURG RD | ||||||||
| Address2: | SUITE #110 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106144544 | ||||||||
| FaxNumber: | 2106793724 | ||||||||
| Practice Location | |||||||||
| Address1: | 255 E SONTERRA BLVD | ||||||||
| Address2: | SUITE #200 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782584075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105810376 | ||||||||
| FaxNumber: | 2106793731 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2013 | ||||||||
| LastUpdateDate: | 11/25/2013 | ||||||||
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| AuthorizedOfficialLastName: | HUDNALL | ||||||||
| AuthorizedOfficialFirstName: | CLAYTON | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2106144544 | ||||||||
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| 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 | 208800000X | 728900 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.