Provider Demographics
NPI:1518985373
Name:GUERRA, ANTONIO FRED (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:FRED
Last Name:GUERRA
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 1:7113 SAN PEDRO AVE # 316
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6219
Mailing Address - Country:US
Mailing Address - Phone:210-745-0084
Mailing Address - Fax:210-745-0139
Practice Address - Street 1:15102 JONES MALTSBERGER RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-3367
Practice Address - Country:US
Practice Address - Phone:210-745-0084
Practice Address - Fax:210-745-0139
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9511208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123438704Medicaid
TX1237387-05Medicaid
TX00JW76Medicare ID - Type Unspecified