Basic Information
| Provider Information | |||||||||
| NPI: | 1790123156 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HATEM | ||||||||
| FirstName: | HATEM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8711 VILLAGE DR STE 114 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782175419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8303204955 | ||||||||
| FaxNumber: | 2104336329 | ||||||||
| Practice Location | |||||||||
| Address1: | 7719 S IH 35 STE 220 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782241469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8303204955 | ||||||||
| FaxNumber: | 2104336329 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2013 | ||||||||
| LastUpdateDate: | 05/29/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0201X | R3856 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
ID Information
| ID | Type | State | Issuer | Description | 379803501 | 05 | TX | MEDICAID |