Provider Demographics
NPI:1831190362
Name:GUAN, DIFU (MD)
Entity type:Individual
Prefix:
First Name:DIFU
Middle Name:
Last Name:GUAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8038 WURZBACH RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3817
Mailing Address - Country:US
Mailing Address - Phone:210-614-0500
Mailing Address - Fax:210-614-4848
Practice Address - Street 1:8038 WURZBACH RD
Practice Address - Street 2:SUITE 340
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3817
Practice Address - Country:US
Practice Address - Phone:210-614-0500
Practice Address - Fax:210-614-4848
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK8761207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX038764902Medicaid
TX8C6909Medicare ID - Type Unspecified