Provider Demographics
NPI:1750355004
Name:LEDBETTER, JOHN D (DO)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:D
Last Name:LEDBETTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 MCCULLOUGH AVE
Mailing Address - Street 2:STE 135
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-5609
Mailing Address - Country:US
Mailing Address - Phone:210-227-9214
Mailing Address - Fax:210-476-8515
Practice Address - Street 1:1303 MCCULLOUGH AVE
Practice Address - Street 2:STE 135
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5609
Practice Address - Country:US
Practice Address - Phone:210-227-9214
Practice Address - Fax:210-476-8515
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5598207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1358285Medicaid
TX8561K0Medicare ID - Type Unspecified
TX1358285Medicaid