Healthcare Provider Details

I. General information

NPI: 1790892776
Provider Name (Legal Business Name): SALLY COMBEST MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 MEDICAL DR
SAN ANTONIO TX
78229-4402
US

IV. Provider business mailing address

UTHSCSA, UTHSCSA, DEPT. ANESTHESIOLOGY 7703 FLOYD CURL DRIVE, RM 321.5E
SAN ANTONIO TX
78229
US

V. Phone/Fax

Practice location:
  • Phone: 210-257-1400
  • Fax:
Mailing address:
  • Phone: 210-358-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberJ4055
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberJ4055
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: