Provider Demographics
NPI:1669565602
Name:LERMA, JUAN J (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:J
Last Name:LERMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:J
Other - Last Name:LERMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1800 NE LOOP 410
Mailing Address - Street 2:STE 400
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5210
Mailing Address - Country:US
Mailing Address - Phone:210-837-9140
Mailing Address - Fax:
Practice Address - Street 1:32 N INWOOD HEIGHTS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-2315
Practice Address - Country:US
Practice Address - Phone:210-837-9140
Practice Address - Fax:210-239-6937
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2159207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF50767Medicare UPIN