Provider Demographics
NPI:1174603724
Name:JIRKA, ANTON J JR (MD)
Entity type:Individual
Prefix:
First Name:ANTON
Middle Name:J
Last Name:JIRKA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8711 VILLAGE DR STE 114
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5419
Mailing Address - Country:US
Mailing Address - Phone:210-690-5700
Mailing Address - Fax:210-558-0428
Practice Address - Street 1:5979 BABCOCK RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-2137
Practice Address - Country:US
Practice Address - Phone:210-690-5700
Practice Address - Fax:210-558-0428
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2018-03-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ2114207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104239203Medicaid
TX104239203Medicaid