Basic Information
| Provider Information | |||||||||
| NPI: | 1831190362 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUAN | ||||||||
| FirstName: | DIFU | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8038 WURZBACH RD | ||||||||
| Address2: | SUITE 340 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106140500 | ||||||||
| FaxNumber: | 2106144848 | ||||||||
| Practice Location | |||||||||
| Address1: | 8038 WURZBACH RD | ||||||||
| Address2: | SUITE 340 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106140500 | ||||||||
| FaxNumber: | 2106144848 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 05/21/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | K8761 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 038764902 | 05 | TX | MEDICAID |