Provider Demographics
NPI:1396508420
Name:REGENESIS MD, PLLC
Entity type:Organization
Organization Name:REGENESIS MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LATCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-931-7370
Mailing Address - Street 1:PO BOX 782248
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78278-2248
Mailing Address - Country:US
Mailing Address - Phone:719-800-5095
Mailing Address - Fax:719-602-3397
Practice Address - Street 1:4835 FREDERICKSBURG RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3627
Practice Address - Country:US
Practice Address - Phone:210-615-7480
Practice Address - Fax:210-614-4972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty