Provider Demographics
NPI:1790760940
Name:CHICA, GERARDO A (MD)
Entity Type:Individual
Prefix:
First Name:GERARDO
Middle Name:A
Last Name:CHICA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7142 SAN PEDRO AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6256
Mailing Address - Country:US
Mailing Address - Phone:210-661-5622
Mailing Address - Fax:210-798-6811
Practice Address - Street 1:2391 NE LOOP 410 STE 405
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5675
Practice Address - Country:US
Practice Address - Phone:210-654-7326
Practice Address - Fax:210-590-8232
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX31236207RN0300X
TXL4883207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00098965OtherMEDICARE RAILROAD
TX154603802Medicaid
TXH71726Medicare UPIN
TX154603802Medicaid