Provider Demographics
NPI:1275990996
Name:WIFI MEDICAL DOCTORS
Entity Type:Organization
Organization Name:WIFI MEDICAL DOCTORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ELIZONDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-237-5498
Mailing Address - Street 1:109 GALLERY CIR STE 127
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3328
Mailing Address - Country:US
Mailing Address - Phone:210-267-1197
Mailing Address - Fax:210-802-4926
Practice Address - Street 1:109 GALLERY CIR STE 127
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3328
Practice Address - Country:US
Practice Address - Phone:210-267-1197
Practice Address - Fax:210-802-4926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7776208000000X, 2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG23827Medicare UPIN