Provider Demographics
NPI:1700872439
Name:BORREGO, ROBERT A III (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:BORREGO
Suffix:III
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 1:359 E HILDEBRAND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-2436
Mailing Address - Country:US
Mailing Address - Phone:210-822-5524
Mailing Address - Fax:210-822-4661
Practice Address - Street 1:359 E HILDEBRAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-2436
Practice Address - Country:US
Practice Address - Phone:210-822-5524
Practice Address - Fax:210-822-4661
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9041207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111722801Medicaid
TXB77137Medicare UPIN
TX111722801Medicaid