Provider Demographics
NPI:1376701565
Name:TEJADA, THOR (MD)
Entity Type:Individual
Prefix:
First Name:THOR
Middle Name:
Last Name:TEJADA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4411 MEDICAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3824
Mailing Address - Country:US
Mailing Address - Phone:210-614-5400
Mailing Address - Fax:210-614-4244
Practice Address - Street 1:12709 TOEPPERWEIN RD STE 306
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3223
Practice Address - Country:US
Practice Address - Phone:210-967-0096
Practice Address - Fax:210-967-0383
Is Sole Proprietor?:No
Enumeration Date:2008-05-26
Last Update Date:2022-02-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXR3604207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology