Provider Demographics
NPI:1073622908
Name:CAVAZOS, ANTONIO III (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:CAVAZOS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7950 FLOYD CURL DR
Mailing Address - Street 2:SUITE 800
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3919
Mailing Address - Country:US
Mailing Address - Phone:210-616-0649
Mailing Address - Fax:210-692-9530
Practice Address - Street 1:7950 FLOYD CURL DR
Practice Address - Street 2:SUITE 800
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3919
Practice Address - Country:US
Practice Address - Phone:210-616-0649
Practice Address - Fax:210-692-9530
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6650174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122910602Medicaid
TX122910602Medicaid
TX00DM80Medicare PIN