Provider Demographics
NPI:1174729560
Name:PADIA, DEEPA (DO)
Entity type:Individual
Prefix:
First Name:DEEPA
Middle Name:
Last Name:PADIA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 CENTRAL PARKWAY NORTH
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5024
Mailing Address - Country:US
Mailing Address - Phone:210-541-4500
Mailing Address - Fax:210-541-4508
Practice Address - Street 1:5000 BAPTIST HEALTH DR
Practice Address - Street 2:STE 102
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1193
Practice Address - Country:US
Practice Address - Phone:210-566-2656
Practice Address - Fax:210-566-2690
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5868207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1872616-06Medicaid
TXM5868OtherTX LICENSE NUMBER
TX8AE503OtherBLUE CROSS BLUE SHIELD
TX8AE503OtherBLUE CROSS BLUE SHIELD