Healthcare Provider Details

I. General information

NPI: 1568422749
Provider Name (Legal Business Name): TOMMY JEROME DOSTER PA-C, MPAS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 MERTON MINTER ST
SAN ANTONIO TX
78229-4404
US

IV. Provider business mailing address

21514 ROAN BLF
SAN ANTONIO TX
78259-2671
US

V. Phone/Fax

Practice location:
  • Phone: 210-617-5300
  • Fax: 210-617-5178
Mailing address:
  • Phone: 210-497-2425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA02509
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: