Provider Demographics
NPI:1770571416
Name:PADILLA MAIZ, JUAN M (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:M
Last Name:PADILLA MAIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2829 BABCOCK RD STE 106
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6009
Mailing Address - Country:US
Mailing Address - Phone:102-951-9055
Mailing Address - Fax:956-630-1078
Practice Address - Street 1:2829 BABCOCK RD STE 106
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6009
Practice Address - Country:US
Practice Address - Phone:210-951-9055
Practice Address - Fax:210-951-9066
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM8896207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199859302Medicaid
TX8F9316Medicare PIN
TX554872YNG9Medicare PIN