Provider Demographics
NPI:1225154842
Name:CARRIZAL, MICHAEL JAY (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAY
Last Name:CARRIZAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E SONTERRA BLVD
Mailing Address - Street 2:#410
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3928
Mailing Address - Country:US
Mailing Address - Phone:210-787-8523
Mailing Address - Fax:
Practice Address - Street 1:16403 HUEBNER RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-1683
Practice Address - Country:US
Practice Address - Phone:210-493-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0997207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH07735Medicare PIN
TXH07735Medicare UPIN