Basic Information
Provider Information
NPI: 1750714184
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ADUN
FirstName: NOSA
MiddleName: E
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 734812
Address2:  
City: DALLAS
State: TX
PostalCode: 753734812
CountryCode: US
TelephoneNumber: 2103589500
FaxNumber: 2103589183
Practice Location
Address1: 2121 SW 36TH ST
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782373360
CountryCode: US
TelephoneNumber: 2103585100
FaxNumber: 2103585157
Other Information
ProviderEnumerationDate: 08/21/2013
LastUpdateDate: 02/08/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/08/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XPA08470TXY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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