Basic Information
| Provider Information | |||||||||
| NPI: | 1962454694 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DO | ||||||||
| FirstName: | JEAN-ANTHONY | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1355 CENTRAL PKWY S | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782325055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105906195 | ||||||||
| FaxNumber: | 2106505993 | ||||||||
| Practice Location | |||||||||
| Address1: | 5000 SCHERTZ PKWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SCHERTZ | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781541399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106509978 | ||||||||
| FaxNumber: | 2106505975 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 06/04/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0000X | P0199 | TX | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics | 207V00000X | P0199 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 284885501 | 05 | TX | MEDICAID |