Organization
BULVERDE FAMILY MEDICINE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFF D ETHRIDGE MD (PHYSICIAN OWNER)
(830) 980-1805
Entity
Organization
Contact information
Practice address
805 KELLY CREEK RD, BULVERDE, TX 78163-3035
(830) 980-1805
(830) 438-5662
Mailing address
805 KELLY CREEK RD, BULVERDE, TX 78163-3035
(830) 980-1805
(830) 438-5662
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
L6877
TX
207Q00000X
Family Medicine Physician
—
—
208M00000X
Hospitalist Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
386676601
—
TX
01
—
L6877
MEDICAL LICENSE
TX
Enumeration date
09/17/2015
Last updated
06/08/2021
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