Provider Demographics
NPI:1255301149
Name:BAQUERO, JEANNIE ALLYSON (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNIE
Middle Name:ALLYSON
Last Name:BAQUERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2219 CARDIGAN HL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-5615
Mailing Address - Country:US
Mailing Address - Phone:210-545-7056
Mailing Address - Fax:
Practice Address - Street 1:1303 MCCULLOUGH AVE
Practice Address - Street 2:SUITE 374
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5615
Practice Address - Country:US
Practice Address - Phone:210-223-5483
Practice Address - Fax:210-292-3828
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5449207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism