Organization
JASPER UROLOGY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAGED RAMZY BOTROS MD (PRESIDENT ( OWNER ))
(409) 384-6835
Entity
Organization
Contact information
Practice address
215 E WATER ST, JASPER, TX 75951-4440
(409) 384-6835
(409) 384-4159
Mailing address
215 E WATER ST, JASPER, TX 75951-4440
(409) 384-6835
(409) 384-4159
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
G7787
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
141628101
—
TX
01
—
45D0484054
CLIA ID NUMBER
TX
Enumeration date
07/06/2005
Last updated
06/23/2010
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