Provider Demographics
NPI:1093710758
Name:BROTHERS, TERESITA MOURET (MD)
Entity Type:Individual
Prefix:
First Name:TERESITA
Middle Name:MOURET
Last Name:BROTHERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 TREBLE CRK APT 724
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4555
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8109 FREDERICKSBURG RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3311
Practice Address - Country:US
Practice Address - Phone:210-575-0250
Practice Address - Fax:210-575-0258
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH10492084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126294109Medicaid
TX8U9623OtherBCBS
8J2674Medicare PIN
TX8U9623OtherBCBS