Healthcare Provider Details

I. General information

NPI: 1619431186
Provider Name (Legal Business Name): ELIZABETH BOHNENBLUST CLANTON, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 05/16/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 AUSTIN HWY
SAN ANTONIO TX
78209-4337
US

IV. Provider business mailing address

1419 AUSTIN HWY
SAN ANTONIO TX
78209-4337
US

V. Phone/Fax

Practice location:
  • Phone: 210-460-7632
  • Fax: 210-591-1192
Mailing address:
  • Phone: 210-460-7632
  • Fax: 210-591-1192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ELIZABETH B. CLANTON
Title or Position: OWNER
Credential: MD
Phone: 210-460-7632