Provider Demographics
NPI:1184669830
Name:CORONADO, TOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:TOMAS
Middle Name:
Last Name:CORONADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 N MAIN
Mailing Address - Street 2:SUITE 719
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-1152
Mailing Address - Country:US
Mailing Address - Phone:210-271-0818
Mailing Address - Fax:
Practice Address - Street 1:730 N MAIN
Practice Address - Street 2:SUITE 719
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-1152
Practice Address - Country:US
Practice Address - Phone:210-271-0818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6541207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000000QL64OtherBLUE CROSS/BLUE SHIELD
TX120097402Medicaid
4059998OtherAETNA
742447517OtherTRICARE
TX17424475170001OtherSTATE OF TEXAS
TX000000QL64OtherBLUE CROSS/BLUE SHIELD
TX120097402Medicaid