Provider Demographics
NPI:1922127414
Name:TAMEZ, ERNESTO M (MD)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:M
Last Name:TAMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ERNESTO
Other - Middle Name:
Other - Last Name:TAMEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10200 BROADWAY STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217
Mailing Address - Country:US
Mailing Address - Phone:210-654-8787
Mailing Address - Fax:210-654-3008
Practice Address - Street 1:10200 BROADWAY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-4431
Practice Address - Country:US
Practice Address - Phone:210-654-8787
Practice Address - Fax:210-654-3008
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ59212083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine