Provider Demographics
NPI:1306814942
Name:GURWITZ, LISA BLUMENTHAL (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:BLUMENTHAL
Last Name:GURWITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:BLUMENTHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4499 MEDICAL DR
Mailing Address - Street 2:SUITE 119
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3735
Mailing Address - Country:US
Mailing Address - Phone:210-614-9400
Mailing Address - Fax:210-614-9244
Practice Address - Street 1:4499 MEDICAL DR
Practice Address - Street 2:SUITE 119
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3735
Practice Address - Country:US
Practice Address - Phone:210-614-9400
Practice Address - Fax:210-614-9244
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8257207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX042201601Medicaid
TXF88342Medicare UPIN
TX042201601Medicaid
TX8372J1Medicare PIN