Provider Demographics
NPI:1689688608
Name:BRIONES, SEGUNDO ABRAHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:SEGUNDO
Middle Name:ABRAHAM
Last Name:BRIONES
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 1:16614 SAN PEDRO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2223
Mailing Address - Country:US
Mailing Address - Phone:210-495-6515
Mailing Address - Fax:210-495-4565
Practice Address - Street 1:16614 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-2223
Practice Address - Country:US
Practice Address - Phone:210-495-6515
Practice Address - Fax:210-495-4565
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127106601Medicaid
TX00530MMedicare PIN
TX127106601Medicaid