Provider Demographics
NPI:1760424790
Name:VIROSLAV, SERGIO (MD)
Entity Type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:
Last Name:VIROSLAV
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 1:400 CONCORD PLAZA DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6991
Mailing Address - Country:US
Mailing Address - Phone:210-804-5400
Mailing Address - Fax:210-396-5385
Practice Address - Street 1:400 CONCORD PLAZA DR STE 300
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6991
Practice Address - Country:US
Practice Address - Phone:210-804-5400
Practice Address - Fax:210-396-5385
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1948207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX041763602Medicaid
TX2795443OtherCIGNA
TX8H3633OtherBCBS
TX4515213OtherAETNA
TXP00015173OtherRAILROAD MEDICARE
TX8A6377Medicare PIN
TX8H3633OtherBCBS