MEDICARE: DR. DEOWALL CHATTAR-CORA M.D.

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	207P00000X	Emergency Medicine Physician	M3496	TX
2	208600000X	Surgery Physician	226264-1	NY
3	208600000X	Surgery Physician	M3496	TX
4	2086S0105X	Surgery of the Hand (Surgery) Physician	M3496	TX
5	2086S0122X	Plastic and Reconstructive Surgery Physician	M3496	TX

General Provider Information

NPI Number	:	1699733576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEOWALL CHATTAR-CORA M.D.

Provider Business Mailing Address
First Line	:	1931 ROGERS RD STE 104
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-4853
Country	:	US
Telephone Number	:	210-265-1924
Fax Number	:	210-265-3387

Provider Business Practice Location Address
First Line	:	11212 STATE HIGHWAY 151
Second Line	:	MEDICAL PLAZA II STE 230
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-4498
Country	:	US
Telephone Number	:	210-265-1924
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	12/30/2024

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