Provider Demographics
NPI:1649722679
Name:KUGLEN, JEFF
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:KUGLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14546 BROOK HOLLOW BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-3810
Mailing Address - Country:US
Mailing Address - Phone:210-363-9062
Mailing Address - Fax:210-579-6636
Practice Address - Street 1:14546 BROOK HOLLOW BLVD STE 303
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-3810
Practice Address - Country:US
Practice Address - Phone:210-363-9062
Practice Address - Fax:210-579-6636
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0731796171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor