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General NPI Number Information
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NPI Number | 1831840008
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Entity Type | Individual
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Provider Name | RICHARD AUGUST BOTHE III PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/10/2022
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Last Update Date | 01/10/2022
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Provider Practice Location Address
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Address Line | 3501 MARIETTA LN
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City | SCHERTZ
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State | TX
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Zip | 78154-1238
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Country | US
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Telephone | 210-602-0250
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Fax |
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Provider Business Mailing Address
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Address Line | 10906 RINDLE RNCH
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City | SAN ANTONIO
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State | TX
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Zip | 78249-3924
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Country | US
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Telephone |
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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