Healthcare Provider Details

I. General information

NPI: 1659556504
Provider Name (Legal Business Name): JESSICA H. STOTTS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 07/29/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 RODGER BROOKE DR.
FORT SAM HOUSTON TX
78234
US

IV. Provider business mailing address

3851 RODGER BROOKE DR
FORT SAM HOUSTON TX
78234
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-5000
  • Fax: 210-916-2077
Mailing address:
  • Phone: 210-539-9582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberN0380
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: