# JASPER UROLOGY ASSOCIATES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659378602
- **Authorized official:** DR. MAGED RAMZY BOTROS MD (PRESIDENT ( OWNER ))
- **Authorized official phone:** (409) 384-6835

## Contact information

- **Practice address:** 215 E WATER ST, JASPER, TX 75951-4440
- **Practice address phone:** (409) 384-6835
- **Practice address fax:** (409) 384-4159
- **Mailing address:** 215 E WATER ST, JASPER, TX 75951-4440
- **Mailing address phone:** (409) 384-6835
- **Mailing address fax:** (409) 384-4159

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | G7787 | TX | Yes |

## Other

- **Enumeration date:** 07/06/2005
- **Last updated:** 06/23/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 141628101 | — | TX |
| 01 | — | 45D0484054 | CLIA ID NUMBER | TX |