Organization
LINDA J. BANTA, M.D., P.A.
Active
Organization
LINDA J. BANTA, M.D., P.A.
Active
Other names
Stone Oak Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA JANE BANTA M.D. (OWNER/PHYSICIAN)
(210) 494-0504
Entity
Organization
Contact information
Practice address
109 GALLERY CIR, SAN ANTONIO, TX 78258-3327
(210) 494-0504
(210) 494-0593
Mailing address
PO BOX 2493, SAN ANTONIO, TX 78299-2493
(210) 494-0504
(210) 494-0593
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
J3779
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0083TJ
BCBS
TX
Enumeration date
03/17/2010
Last updated
08/09/2010
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