Provider Demographics
NPI:1952483166
Name:DOVE, AMANDA MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:MARY
Last Name:DOVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5282 MEDICAL DR
Mailing Address - Street 2:SUITE 540
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4849
Mailing Address - Country:US
Mailing Address - Phone:210-614-9300
Mailing Address - Fax:210-614-8314
Practice Address - Street 1:5282 MEDICAL DR
Practice Address - Street 2:SUITE 540
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6071
Practice Address - Country:US
Practice Address - Phone:210-614-9300
Practice Address - Fax:210-614-8314
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG88272080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134886407Medicaid
TX134886407Medicaid