Provider Demographics
NPI:1831394105
Name:PINKSTON FAMILY PRACTICE
Entity type:Organization
Organization Name:PINKSTON FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AIMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULBAKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:210-639-7757
Mailing Address - Street 1:PO BOX 29425
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-0425
Mailing Address - Country:US
Mailing Address - Phone:210-615-7911
Mailing Address - Fax:210-615-0585
Practice Address - Street 1:4499 MEDICAL DR STE 170
Practice Address - Street 2:10865 SHAENFIELD RD
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3784
Practice Address - Country:US
Practice Address - Phone:210-615-7911
Practice Address - Fax:210-615-0585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9871202C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical ExaminerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG50561Medicare UPIN
00555LMedicare ID - Type Unspecified