Basic Information
| Provider Information | |||||||||
| NPI: | 1801988928 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANCHEZ | ||||||||
| FirstName: | TEOFILO | ||||||||
| MiddleName: | RESENDIZ | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1045 CENTRAL PARKWAY NORTH | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782325024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105414500 | ||||||||
| FaxNumber: | 2105414508 | ||||||||
| Practice Location | |||||||||
| Address1: | 7913 BANDERA RD | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782506511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106809393 | ||||||||
| FaxNumber: | 2106817906 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 10/05/2012 | ||||||||
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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 | 207Q00000X | M5480 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8K4496 | 01 | TX | INDIVIDUAL PTAN | OTHER | FS0089006 | 01 | TX | DEA | OTHER | T0150108 | 01 | TX | TEXAS CONTROLLED SUBSTANCE | OTHER | #8DJ151 | 01 | TX | BCBS HMO/PPO PROVIDER ID | OTHER | 1846859-09 | 05 | TX | MEDICAID | 00U72Z | 01 | TX | GROUP PTAN | OTHER |