Provider Demographics
NPI:1659574911
Name:BOBBALA, GOVARDHAN REDDY (MD)
Entity Type:Individual
Prefix:
First Name:GOVARDHAN
Middle Name:REDDY
Last Name:BOBBALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11212 STATE HIGHWAY 151 STE 3006
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4498
Mailing Address - Country:US
Mailing Address - Phone:210-703-8375
Mailing Address - Fax:210-703-8377
Practice Address - Street 1:11212 STATE HIGHWAY 151 STE 3006
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4498
Practice Address - Country:US
Practice Address - Phone:210-703-8375
Practice Address - Fax:210-703-8377
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1524207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine