Provider Demographics
NPI:1790033512
Name:GERARDO E. CARCAMO, MD PA
Entity Type:Organization
Organization Name:GERARDO E. CARCAMO, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D., PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARCAOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-220-1726
Mailing Address - Street 1:414 NAVARRO ST
Mailing Address - Street 2:SUITE 810
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-2577
Mailing Address - Country:US
Mailing Address - Phone:210-220-1726
Mailing Address - Fax:210-224-3058
Practice Address - Street 1:414 NAVARRO ST
Practice Address - Street 2:SUITE 810
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-2577
Practice Address - Country:US
Practice Address - Phone:210-220-1726
Practice Address - Fax:210-224-3058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4014208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0073CFOtherBLUE CROSS/BLUE SHIELD
TX029449801Medicaid
TX020045233OtherMEDICARE RAIL ROAD
TX268085OtherHUMANA
TX5220564OtherAETNA
TX4160893OtherBLUE LINK
TX0073CFOtherBLUE CROSS/BLUE SHIELD