Unknown Individual – Family Medicine Physician, NPI 1134162381

Family Medicine Physician

Unknown Individual is a healthcare provider. based in San antonio, Texas. specializing in Family Medicine Physician. They hold a License No. H8061 (TX). The NPI Number for Unknown Individual is 1134162381

Main info

Organization

Inactive

37 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1134162381

Phone

(210) 403-3490

Address

19016 STONE OAK PKWY

Deactivation Date

28 January 2022

Doctor Profile

Medical School Name

DES MOINES UNIVERSITY OF OSTEOPATHIC MEDICINE AND HEALTH SCIENCES

Secondary Phone

2104905911

Graduation Year

1989 (37 years ago)

PAC ID

6103811872

Group Practice PAC ID

9335193143

Professional Enrollment ID

I20080730000526

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness75

Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

Stone Oak Parkway, San Antonio, Bexar County, Texas, 78232, United States
SUITE 100
SAN ANTONIO, TX 782583280
Phone: (210) 403-3490
Fax: (210) 403-2042
Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 78258)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 9335193143View full group profile