Basic Information
| Provider Information | |||||||||
| NPI: | 1447419619 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VIZURRAGA | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | ENRIQUE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18626 HARDY OAK BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782584228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104959047 | ||||||||
| FaxNumber: | 2102932930 | ||||||||
| Practice Location | |||||||||
| Address1: | 3551 ROGER BROOKE DR | ||||||||
| Address2: | |||||||||
| City: | FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109164141 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2008 | ||||||||
| LastUpdateDate: | 11/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 65913 | GA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 36201 | SC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0114X | Q1326 | TX | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | 207X00000X | Q1326 | TX | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.