Active NPI
Pro Physicians Clinic, PA
- Radiation Oncology Physician
- Live Oak, TX
National Provider Identifier
1821229717
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiation Oncology Physician
- Legal business name
- PRO PHYSICIANS CLINIC, PA
- Doing business as
- Pro Physicians Clinic, PA
- Practice address
- 12705 Toepperwein Rd
Live Oak, TX 78233-3257 - Phone
- (210) 816-4770
- Fax
- (210) 816-4771
- NPI assigned
- Jul 27, 2009
- Organization subpart
- Yes
- Parent organization
- PRO PHYSICIANS CLINIC, PA
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jon D Tryggestad
- Title
- Ceo
- Phone
- (817) 886-8730
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Radiation Oncology Physician | 2085R0001X | Primary |
Addresses
Primary practice location
12705 Toepperwein Rd
Live Oak, TX 78233-3257
Mailing address
8019 S New Braunfels Ste 101
San Antonio, TX 78235-1069
Phone (210) 816-4770
Other practice location 1
8019 S New Braunfels Ste 101
San Antonio, TX 78235-1069
Phone (210) 981-3051
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0A3406 | Other | TX | MEDICARE PTAN |
Other names 1
- Pro Physicians Clinic, PA
National Provider Directory
National Provider Directory- Part of
- Pro Physicians Clinic PA
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248652800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1551052800000",
"number": "1821229717",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8019 S NEW BRAUNFELS STE 101",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782351069",
"telephone_number": "210-816-4770",
"fax_number": "210-816-4771"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12705 TOEPPERWEIN RD",
"city": "LIVE OAK",
"state": "TX",
"postal_code": "782333257",
"telephone_number": "210-816-4770",
"fax_number": "210-816-4771"
}
],
"practiceLocations": [
{
"address_1": "8019 S New Braunfels Ste 101",
"address_purpose": "LOCATION",
"city": "San Antonio",
"state": "TX",
"postal_code": "782351069",
"country_code": "US",
"telephone_number": "210-981-3051",
"fax_number": "210-981-3052",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "PRO PHYSICIANS CLINIC, PA",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "PRO PHYSICIANS CLINIC, PA",
"enumeration_date": "2009-07-27",
"last_updated": "2019-02-25",
"status": "A",
"authorized_official_last_name": "TRYGGESTAD",
"authorized_official_first_name": "JON",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "817-886-8730"
},
"taxonomies": [
{
"code": "2085R0001X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Radiology, Radiation Oncology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "0A3406",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Pro Physicians Clinic, PA",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Pro Physicians Clinic, PA",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Live Oak, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.