Provider Demographics
NPI:1922078864
Name:THOMAS, AZREENA BALSAVER (MD)
Entity Type:Individual
Prefix:
First Name:AZREENA
Middle Name:BALSAVER
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8632 FREDERICKSBURG RD STE 112
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1266
Mailing Address - Country:US
Mailing Address - Phone:210-593-0900
Mailing Address - Fax:210-593-4474
Practice Address - Street 1:8632 FREDERICKSBURG RD STE 112
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1266
Practice Address - Country:US
Practice Address - Phone:210-593-0900
Practice Address - Fax:210-593-4474
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH66482084N0400X, 2084N0600X, 2084E0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0037QSOtherBLUE CROSS
TX13448030-11Medicaid
TX13448030-11Medicaid
TX0037QSOtherBLUE CROSS