Provider Demographics
NPI:1619431186
Name:ELIZABETH BOHNENBLUST CLANTON, MD, PA
Entity Type:Organization
Organization Name:ELIZABETH BOHNENBLUST CLANTON, MD, PA
Other - Org Name:ELIZABETH BOHNENBLUST CLANTON, MD, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:B
Authorized Official - Last Name:CLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-460-7632
Mailing Address - Street 1:1419 AUSTIN HWY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-4337
Mailing Address - Country:US
Mailing Address - Phone:210-460-7632
Mailing Address - Fax:210-591-1192
Practice Address - Street 1:1419 AUSTIN HWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-4337
Practice Address - Country:US
Practice Address - Phone:210-460-7632
Practice Address - Fax:210-591-1192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-29
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty