Provider Demographics
NPI:1407513443
Name:MEDVON MEDICAL CLINIC PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MEDVON MEDICAL CLINIC PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:O
Authorized Official - Last Name:NJOKU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-505-7073
Mailing Address - Street 1:10807 PERRIN BEITEL RD STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-3144
Mailing Address - Country:US
Mailing Address - Phone:210-505-7073
Mailing Address - Fax:210-588-0006
Practice Address - Street 1:10807 PERRIN BEITEL RD STE 120
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-3144
Practice Address - Country:US
Practice Address - Phone:210-847-1486
Practice Address - Fax:210-588-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-24
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX41005659OtherDL