Provider Demographics
NPI:1851512321
Name:OSCAR J. CERDA, M.D., P.A.
Entity Type:Organization
Organization Name:OSCAR J. CERDA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-525-1668
Mailing Address - Street 1:PO BOX 700596
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78270-0596
Mailing Address - Country:US
Mailing Address - Phone:210-525-1668
Mailing Address - Fax:210-525-1669
Practice Address - Street 1:5410 FREDERICKSBURG RD
Practice Address - Street 2:SUITE 112
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3554
Practice Address - Country:US
Practice Address - Phone:210-733-3008
Practice Address - Fax:210-733-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0672207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157930201Medicaid
TX157930201Medicaid
TX00181UMedicare PIN