Provider Demographics
NPI:1881630721
Name:HAWORTH, BRIAN JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JOHN
Last Name:HAWORTH
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:PO BOX 2408
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78298-2408
Mailing Address - Country:US
Mailing Address - Phone:210-485-1850
Mailing Address - Fax:210-493-9500
Practice Address - Street 1:16607 BLANCO RD
Practice Address - Street 2:SUITE 603
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1941
Practice Address - Country:US
Practice Address - Phone:210-495-1850
Practice Address - Fax:210-493-9500
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0824207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197570801Medicaid
TX8BN921OtherBLUE CROSS BLUE SHIELD
TX197570801Medicaid