Provider Demographics
NPI:1255445409
Name:KUJAWA, PLES LATSON (MD)
Entity type:Individual
Prefix:
First Name:PLES
Middle Name:LATSON
Last Name:KUJAWA
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 1:12602 TOEPPERWEIN RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3259
Mailing Address - Country:US
Mailing Address - Phone:210-599-8110
Mailing Address - Fax:210-257-0627
Practice Address - Street 1:12602 TOEPPERWEIN RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233-3259
Practice Address - Country:US
Practice Address - Phone:210-599-8110
Practice Address - Fax:210-257-0627
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5270207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114144202Medicaid
TX200043232Medicare PIN
TXB24147Medicare UPIN
TX114144202Medicaid