Healthcare Provider Details

I. General information

NPI: 1730194887
Provider Name (Legal Business Name): DEBBIE ARNOLD BOETTNER PA-C / BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 W 2ND ST
ELGIN TX
78621
US

IV. Provider business mailing address

PO BOX 1890
GONZALES TX
78629-1390
US

V. Phone/Fax

Practice location:
  • Phone: 512-229-3334
  • Fax: 512-229-3335
Mailing address:
  • Phone: 830-672-6511
  • Fax: 830-672-6430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00538
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: