Provider Demographics
NPI:1396066163
Name:MIWA, EDWARD ALEJANDRO (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:ALEJANDRO
Last Name:MIWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6818
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-0818
Mailing Address - Country:US
Mailing Address - Phone:830-309-8621
Mailing Address - Fax:
Practice Address - Street 1:2515 CASTROVILLE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78237-3359
Practice Address - Country:US
Practice Address - Phone:210-290-8350
Practice Address - Fax:210-290-8325
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN7147207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine