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General NPI Number Information
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NPI Number | 1659574911
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Entity Type | Individual
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Provider Name | GOVARDHAN REDDY BOBBALA MD
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Gender | Male
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 11212 STATE HIGHWAY 151 STE 3006
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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 | 210-703-8375
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Fax | 210-703-8377
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Provider Business Mailing Address
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Address Line | 11212 STATE HIGHWAY 151 STE 3006
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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 | 210-703-8375
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Fax | 210-703-8377
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | P1524
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | P1524
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License Number State | TX
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