Healthcare Provider Details

I. General information

NPI: 1578024170
Provider Name (Legal Business Name): LYDIA GRACE ROWARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYDIA GRACE KORE MD

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8811 VILLAGE DR
SAN ANTONIO TX
78217-5415
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 210-297-2000
  • Fax:
Mailing address:
  • Phone: 210-916-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4271085
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberW2120
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number92082
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101271452
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: