Individual
DR. RAVI BOTLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
621 CAMDEN STREET, SUITE 202, SAN ANTONIO, TX 78215-1639
(210) 253-3422
(210) 227-9833
Mailing address
PO BOX 75235, DALLAS, TX 75235-0629
(214) 424-2200
(214) 231-2159
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
J7912
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136549604
—
TX
01
—
87500S
BC/BS
TX
01
—
930072561
MEDICARE - RAILROAD
TX
Enumeration date
09/20/2006
Last updated
02/22/2017
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