Provider Demographics
NPI:1740205418
Name:MASTROVICH, JOHN DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:MASTROVICH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:20650 STONE OAK PKWY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7355
Mailing Address - Country:US
Mailing Address - Phone:210-342-6200
Mailing Address - Fax:210-342-6201
Practice Address - Street 1:20650 STONE OAK PKWY
Practice Address - Street 2:SUITE 106
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7355
Practice Address - Country:US
Practice Address - Phone:210-342-6200
Practice Address - Fax:210-342-6201
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL2449207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H51928Medicare UPIN
TX8F3752Medicare PIN