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General NPI Number Information
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NPI Number | 1508108887
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Entity Type | Organization
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Legal Business Name | ELITE PLASTIC & RECONSTRUCTIVE SURGERY, PA
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Dates
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Enumeration Date | 03/25/2013
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 11212 STATE HIGHWAY 151 MEDICAL PLAZA #2 SUITE 230
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City | SAN ANTONIO
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State | TX
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Zip | 78251-4498
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Country | US
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Telephone | 210-265-1924
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Fax | 210-265-3387
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Provider Business Mailing Address
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Address Line | 1931 ROGERS RD STE 104
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City | SAN ANTONIO
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State | TX
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Zip | 78251-4853
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Country | US
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Telephone | 210-265-1924
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Fax | 210-265-3387
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Authorized Official
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Title or Position | OWNER/MD
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Name | DR. DEOWALL CHATTAR-CORA
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Credential | MD
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Telephone | 210-265-1924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | M3496
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License Number State | TX
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