Provider Demographics
NPI:1457399081
Name:TOMASOVIC, JERRY J (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:J
Last Name:TOMASOVIC
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:PO BOX 34713
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78265-4713
Mailing Address - Country:US
Mailing Address - Phone:210-615-2333
Mailing Address - Fax:210-490-5024
Practice Address - Street 1:525 OAK CENTRE DR
Practice Address - Street 2:SUITE #400
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3944
Practice Address - Country:US
Practice Address - Phone:210-615-2333
Practice Address - Fax:210-490-5024
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG77302084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132968207Medicaid
TX742506891OtherTAX ID
TX8AP903OtherBCBSTX THRU HILL COUNTRY
TX095077602Medicaid
TX00891NOtherBLUE CROSS ID #
TXP00728995OtherRAILROAD MEDICARE THRU HILL COUNTRY MONITORING
TX132968209Medicaid
TX8671K0Medicare ID - Type Unspecified
TX8AP903OtherBCBSTX THRU HILL COUNTRY
TX132968209Medicaid