Provider Demographics
NPI:1972500783
Name:PEDROZA, GREGORIO ELIZONDO III (MD)
Entity Type:Individual
Prefix:
First Name:GREGORIO
Middle Name:ELIZONDO
Last Name:PEDROZA
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:8637 FREDERICKSBURG RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1283
Mailing Address - Country:US
Mailing Address - Phone:210-617-4708
Mailing Address - Fax:210-617-4075
Practice Address - Street 1:13750 SAN PEDRO
Practice Address - Street 2:SUITE 140
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-4375
Practice Address - Country:US
Practice Address - Phone:210-490-9087
Practice Address - Fax:210-496-1285
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2023-01-25
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Provider Licenses
StateLicense IDTaxonomies
TXK3388207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
J13641Medicare UPIN