Provider Demographics
NPI:1255398699
Name:SIOCO, GERALDO M (MD)
Entity type:Individual
Prefix:
First Name:GERALDO
Middle Name:M
Last Name:SIOCO
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 1:1545 BENTON WOODS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4494
Mailing Address - Country:US
Mailing Address - Phone:210-408-6792
Mailing Address - Fax:
Practice Address - Street 1:9465 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1508
Practice Address - Country:US
Practice Address - Phone:210-614-8800
Practice Address - Fax:210-614-8880
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2337207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117571306Medicaid
TX0015GNOtherBCBS GROUP
TX8B0460OtherBCBS TX
TX8B0460OtherBCBS TX
TX117571306Medicaid