Healthcare Provider Details

I. General information

NPI: 1780629220
Provider Name (Legal Business Name): WOMEN'S CLINIC OF DIMMIT & ZAVALA,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 HOSPITAL DRIVE
CARRIZO SPRINGS TX
78834-3836
US

IV. Provider business mailing address

706 HOSPITAL DRIVE
CARRIZO SPRINGS TX
78834-3836
US

V. Phone/Fax

Practice location:
  • Phone: 830-876-9625
  • Fax: 830-876-5752
Mailing address:
  • Phone: 830-876-9625
  • Fax: 830-876-5752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHEAL ANTHONY BUTLER
Title or Position: ADMINISTRATOR
Credential: MD
Phone: 830-876-9625