Provider Demographics
NPI:1356621189
Name:RAUL HIDALGO DPM PA
Entity type:Organization
Organization Name:RAUL HIDALGO DPM PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HIDALGO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:210-222-2990
Mailing Address - Street 1:19179 BLANCO RD
Mailing Address - Street 2:SUITE 105 BOX 403
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4042
Mailing Address - Country:US
Mailing Address - Phone:210-222-2990
Mailing Address - Fax:210-227-5575
Practice Address - Street 1:526 CAMDEN ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1924
Practice Address - Country:US
Practice Address - Phone:210-222-2990
Practice Address - Fax:210-227-5575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15999213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty