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General NPI Number Information
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NPI Number | 1659378602
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Entity Type | Organization
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Legal Business Name | JASPER UROLOGY ASSOCIATES
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Dates
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Enumeration Date | 07/06/2005
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Last Update Date | 06/23/2010
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Provider Practice Location Address
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Address Line | 215 E WATER ST
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City | JASPER
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State | TX
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Zip | 75951-4440
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Country | US
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Telephone | 409-384-6835
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Fax | 409-384-4159
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Provider Business Mailing Address
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Address Line | 215 E WATER ST
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City | JASPER
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State | TX
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Zip | 75951-4440
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Country | US
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Telephone | 409-384-6835
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Fax | 409-384-4159
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Authorized Official
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Title or Position | PRESIDENT ( OWNER )
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Name | DR. MAGED RAMZY BOTROS
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Credential | MD
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Telephone | 409-384-6835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | G7787
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License Number State | TX
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