Organization
DIGESTIVE DISEASES CENTER OF SOUTH TEXAS, PLLC
Active
Organization
DIGESTIVE DISEASES CENTER OF SOUTH TEXAS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAVI BOTLA M.D. (PRESIDENT)
(210) 253-3422
Entity
Organization
Contact information
Practice address
621 CAMDEN ST, SAN ANTONIO, TX 78215-1612
(210) 253-3422
(210) 227-9833
Mailing address
PO BOX 17650, SAN ANTONIO, TX 78217-0650
(210) 253-3422
(210) 227-9833
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00T16Z
BC/BS
TX
05
—
085153702
—
TX
Enumeration date
09/20/2006
Last updated
11/19/2013
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