Provider Demographics
NPI:1689104846
Name:DIRECT MEDICAL PLLC
Entity Type:Organization
Organization Name:DIRECT MEDICAL PLLC
Other - Org Name:DIRECT MED CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:MOCZYGEMBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-264-5500
Mailing Address - Street 1:1010 NW LOOP 410 STE 100A
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-2220
Mailing Address - Country:US
Mailing Address - Phone:210-886-8031
Mailing Address - Fax:210-886-8059
Practice Address - Street 1:1010 NW LOOP 410 STE 100A
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2220
Practice Address - Country:US
Practice Address - Phone:210-886-8031
Practice Address - Fax:210-886-8059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-19
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty