Individual
LINDA J. BANTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
109 GALLERY CIR, SUITE 135, 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
—
81342X
BCBS OF TEXAS
TX
01
—
CK2746
MEDICARE RR
—
Enumeration date
08/10/2005
Last updated
06/04/2010
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