Provider Demographics
NPI:1154351401
Name:MASOZERA, NICHOLAS M (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:M
Last Name:MASOZERA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:3503 PAESANOS PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1225
Mailing Address - Country:US
Mailing Address - Phone:210-492-8922
Mailing Address - Fax:210-479-2010
Practice Address - Street 1:3503 PAESANOS PKWY STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1225
Practice Address - Country:US
Practice Address - Phone:210-492-8922
Practice Address - Fax:210-479-2010
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL5826207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163379104Medicaid
TX8J1926OtherBCBS
TXG42743Medicare UPIN