Organization
STOP SA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BERTRAM W. ROBERTS MD,MPH, DRPH, MHA, (PROGRAM SPONSOR)
(210) 736-4405
Entity
Organization
Contact information
Practice address
3780 N.W. LOOP 410, SAN ANTONIO, TX 78229
(210) 736-4405
(210) 736-4407
Mailing address
3780 N.W. LOOP 410, SAN ANTONIO, TX 78229
(210) 736-4405
(210) 736-4407
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
E8143
TX
2084N0400X
Neurology Physician
K5178
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
131802409
—
TX
Enumeration date
07/30/2010
Last updated
07/30/2010
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