Provider Demographics
NPI:1477549830
Name:UZQUIANO, NELSON GUILLERMO (MD)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:GUILLERMO
Last Name:UZQUIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7418 JOHN SMITH
Mailing Address - Street 2:SUITE 218
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6020
Mailing Address - Country:US
Mailing Address - Phone:210-614-0959
Mailing Address - Fax:210-614-7522
Practice Address - Street 1:200 W OLLIE ST
Practice Address - Street 2:
Practice Address - City:LLANO
Practice Address - State:TX
Practice Address - Zip Code:78643-2628
Practice Address - Country:US
Practice Address - Phone:830-997-7129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2009-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK236862085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197247301Medicaid
OK200037680AMedicaid
OK7166711OtherAETNA
OK487023201OtherDOL
TX8M2157OtherBCBS
TXP00636050OtherMEDICARE RAILROAD
TX8M2157OtherBCBS
OK200037680AMedicaid
TXP00636050OtherMEDICARE RAILROAD