Provider Demographics
NPI:1326127150
Name:SAN ANTONIO BONE & JOINT CLINIC, P.A.
Entity Type:Organization
Organization Name:SAN ANTONIO BONE & JOINT CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT (OWNER)
Authorized Official - Prefix:
Authorized Official - First Name:ERADIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ARREDONDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-226-9311
Mailing Address - Street 1:730 N MAIN AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-1152
Mailing Address - Country:US
Mailing Address - Phone:210-226-9311
Mailing Address - Fax:210-225-6270
Practice Address - Street 1:730 N MAIN AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-1152
Practice Address - Country:US
Practice Address - Phone:210-226-9311
Practice Address - Fax:210-225-6270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8137207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX17610330OtherU.S.DEPT. OF LABOR
TX17610330OtherU.S.DEPT. OF LABOR