Provider Demographics
NPI:1275526410
Name:DE SEQUERA, GERARDO ALFONSO (MD)
Entity Type:Individual
Prefix:MR
First Name:GERARDO
Middle Name:ALFONSO
Last Name:DE SEQUERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:524 SINGING OAKS STE 200
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78070-6509
Mailing Address - Country:US
Mailing Address - Phone:830-620-9429
Mailing Address - Fax:830-620-9495
Practice Address - Street 1:524 SINGING OAKS STE 200
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78070-6509
Practice Address - Country:US
Practice Address - Phone:830-620-9429
Practice Address - Fax:830-620-9495
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2199207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1117707-04OtherWELLMED MEDICAID
TX364195YLPSOtherWELLMED MEDICARE
TX111770701Medicaid