Provider Demographics
NPI:1417644873
Name:ACCESSION MEDICAL WAIVER DIVISION
Entity Type:Organization
Organization Name:ACCESSION MEDICAL WAIVER DIVISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ACCESSION MEDICAL WAIVER DIV
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-652-9205
Mailing Address - Street 1:550 D WEST , SUITE 1
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78150
Mailing Address - Country:US
Mailing Address - Phone:210-652-9205
Mailing Address - Fax:
Practice Address - Street 1:550 D WEST , SUITE 1
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78150
Practice Address - Country:US
Practice Address - Phone:210-652-9205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty