Healthcare Provider Details

I. General information

NPI: 1982723946
Provider Name (Legal Business Name): LAWRENCE JOEL HOBERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13409 GEORGE RD
SAN ANTONIO TX
78230-3064
US

IV. Provider business mailing address

13409 GEORGE RD
SAN ANTONIO TX
78230-3064
US

V. Phone/Fax

Practice location:
  • Phone: 210-492-8922
  • Fax: 210-479-2010
Mailing address:
  • Phone: 210-492-8922
  • Fax: 210-479-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberE3565
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: