Organization
WALTER W. ROOT, M.D.P.A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TAMMY FOUNTAIN (OFFICE MANAGER)
(210) 692-0224
Entity
Organization
Contact information
Practice address
4242 MEDICAL DR, SUITE 6300, SAN ANTONIO, TX 78229-5640
(210) 614-8400
(210) 614-8165
Mailing address
4242 MEDICAL DR, SUITE 6300, SAN ANTONIO, TX 78229-5640
(210) 614-8400
(210) 614-8165
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
M6366
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
TX
Enumeration date
03/03/2009
Last updated
03/03/2009
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