Provider Demographics
NPI:1972617009
Name:SOUTHWEST ALLERGY & ASTHMA CENTER
Entity type:Organization
Organization Name:SOUTHWEST ALLERGY & ASTHMA CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:G
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:210-616-0690
Mailing Address - Street 1:3903 WISEMAN BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4417
Mailing Address - Country:US
Mailing Address - Phone:210-767-0690
Mailing Address - Fax:210-614-8746
Practice Address - Street 1:3903 WISEMAN BLVD STE 202
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4417
Practice Address - Country:US
Practice Address - Phone:210-616-0690
Practice Address - Fax:210-614-8746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8728174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty