Provider Demographics
NPI:1245212232
Name:CHICA, MOISES ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:MOISES
Middle Name:ALEXANDER
Last Name:CHICA
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 1:9480 HUEBNER RD.
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1657
Mailing Address - Country:US
Mailing Address - Phone:210-615-1311
Mailing Address - Fax:210-615-6996
Practice Address - Street 1:9480 HUEBNER RD
Practice Address - Street 2:SUITE 310
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1655
Practice Address - Country:US
Practice Address - Phone:210-615-1311
Practice Address - Fax:210-615-6996
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9656207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F4595OtherMEDICARE PTAN
TX8F4595OtherMEDICARE PTAN