Provider Demographics
NPI:1114939527
Name:NEIDRE, ARVO (MD)
Entity Type:Individual
Prefix:DR
First Name:ARVO
Middle Name:
Last Name:NEIDRE
Suffix:
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 1:9150 HUEBNER RD
Mailing Address - Street 2:STE 350
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1558
Mailing Address - Country:US
Mailing Address - Phone:210-561-7234
Mailing Address - Fax:210-561-7240
Practice Address - Street 1:9150 HUEBNER RD
Practice Address - Street 2:STE 350
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1558
Practice Address - Country:US
Practice Address - Phone:210-561-7234
Practice Address - Fax:210-561-7240
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6862174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1101982Medicaid
TXB25118Medicare UPIN
TX1101982Medicaid