Healthcare Provider Details

I. General information

NPI: 1851380661
Provider Name (Legal Business Name): SARASWATHI GOPALAN NAIR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 ROGER BROOKE DR
SAN ANTONIO TX
78234-4504
US

IV. Provider business mailing address

3551 ROGER BROOKE DR JBSA FORT SAM HOUSTON
SAN ANTONIO TX
78234-4504
US

V. Phone/Fax

Practice location:
  • Phone: 210-539-0958
  • Fax: 210-521-2574
Mailing address:
  • Phone: 210-539-0958
  • Fax: 210-521-2574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number055822
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: