MEDICARE: UROGYNECOLOGY OF SAN ANTONIO PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2088F0040X	Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
2	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician

General Provider Information

NPI Number	:	1134775018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UROGYNECOLOGY OF SAN ANTONIO PLLC

Provider Business Mailing Address
First Line	:	335 E SONTERRA BLVD STE 170
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4068
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	335 E SONTERRA BLVD STE 170
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4068
Country	:	US
Telephone Number	:	210-525-1668
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	ASH DABBOUS
Credential	:	MD
Telephone Number	:	210-525-1668

Provider Enumeration Date	:	08/15/2019
Last Update Date	:	01/21/2025

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