Provider Demographics
NPI:1538264213
Name:JOHN MASTROVICH, M.D., P.A.
Entity type:Organization
Organization Name:JOHN MASTROVICH, M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MASTROVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-342-6200
Mailing Address - Street 1:20650 STONE OAK PKWY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7355
Mailing Address - Country:US
Mailing Address - Phone:210-342-6200
Mailing Address - Fax:210-342-6201
Practice Address - Street 1:20650 STONE OAK PKWY
Practice Address - Street 2:SUITE 106
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7355
Practice Address - Country:US
Practice Address - Phone:210-342-6200
Practice Address - Fax:210-342-6201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2449207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W920Medicare PIN