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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