Provider Demographics
NPI:1770526444
Name:DEYKIN, BRAD A (MD)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:A
Last Name:DEYKIN
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 1:10628 CULEBRA RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-1320
Mailing Address - Country:US
Mailing Address - Phone:210-520-3737
Mailing Address - Fax:
Practice Address - Street 1:10628 CULEBRA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-1320
Practice Address - Country:US
Practice Address - Phone:210-520-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9966207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BZ289OtherBCBSTX
TX8AN322OtherBCBSTX
TX199314903Medicaid
TX8AN322OtherBCBSTX
TX8BZ289OtherBCBSTX