Healthcare Provider Details

I. General information

NPI: 1780864595
Provider Name (Legal Business Name): ELIZABETH B. CLANTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY E. BOHNENBLUST M.D.

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
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 TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberN6819
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberN6819
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberN6819
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: