Provider Demographics
NPI:1235128240
Name:STONE OAK RHEUMATOLOGY PA
Entity Type:Organization
Organization Name:STONE OAK RHEUMATOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-490-1111
Mailing Address - Street 1:155 E SONTERRA BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3987
Mailing Address - Country:US
Mailing Address - Phone:210-490-1111
Mailing Address - Fax:210-490-3833
Practice Address - Street 1:155 E SONTERRA BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3987
Practice Address - Country:US
Practice Address - Phone:210-490-1111
Practice Address - Fax:210-490-3833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2819207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA002OtherCHAMPUS
TX5397113OtherAETNA
TX00347ROtherBLUE CROSS BLUE SHIELD
TX5397113OtherAETNA
TX8769MDMedicare ID - Type Unspecified