Provider Demographics
NPI:1043264138
Name:JENEBY, THOMAS T (M D)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:T
Last Name:JENEBY
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7272 WURZBACH RD
Mailing Address - Street 2:SUITE 801
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4801
Mailing Address - Country:US
Mailing Address - Phone:210-270-8595
Mailing Address - Fax:210-270-8988
Practice Address - Street 1:7272 WURZBACH RD
Practice Address - Street 2:SUITE 801
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-4801
Practice Address - Country:US
Practice Address - Phone:210-270-8595
Practice Address - Fax:210-270-8988
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-21
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9748174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171049301Medicaid
TXH64357Medicare UPIN
TX00938XMedicare ID - Type Unspecified