Provider Demographics
NPI:1629200027
Name:DR. ALEX DE JESUS RHEUMATOLOGY PA
Entity Type:Organization
Organization Name:DR. ALEX DE JESUS RHEUMATOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:DE JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:210-396-7410
Mailing Address - Street 1:7959 FREDERICKSBURG RD
Mailing Address - Street 2:SUITE 135
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3430
Mailing Address - Country:US
Mailing Address - Phone:210-396-7410
Mailing Address - Fax:210-396-7241
Practice Address - Street 1:7959 FREDERICKSBURG RD
Practice Address - Street 2:SUITE 135
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3430
Practice Address - Country:US
Practice Address - Phone:210-396-7410
Practice Address - Fax:210-396-7241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5866207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A5279Medicare PIN