Linda J. Banta, M.D., P.a.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

J3779 Issued in TX

Legal business name

LINDA J. BANTA, M.D., P.A.

Doing business as

Stone Oak Dermatology

Practice address

109 Gallery Cir
San Antonio, TX 78258-3327

Phone

(210) 494-0504

Fax

(210) 494-0593

NPI assigned

Mar 17, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Linda Jane Banta, M.D.NPI 1144221359

Title

Owner/Physician

Phone

(210) 494-0504

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Stone Oak Dermatology Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Linda J. Banta, M.D.

  • Dermatology Physician
  • San Antonio, TX
  • NPI 1144221359
  Medicare reassignment Care Compare group NPD Authorized official
• Steven Charles Blakeley, PA-C

  • Physician Assistant
  • San Antonio, TX
  • NPI 1528678349
  Medicare reassignment Care Compare group
• Raquel Rae Martinez, FNP-C

  • Nurse Practitioner
  • San Antonio, TX
  • NPI 1184584526
  NPD (past)
• Patricia Anne Burden, MD

  • Dermatology Physician
  • Williamsville, NY
  • NPI 1538228739
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1268784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281312000000",
    "number": "1013231216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2493",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782992493",
            "telephone_number": "210-494-0504",
            "fax_number": "210-494-0593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 GALLERY CIR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782583327",
            "telephone_number": "210-494-0504",
            "fax_number": "210-494-0593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINDA J. BANTA, M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-17",
        "last_updated": "2010-08-09",
        "status": "A",
        "authorized_official_last_name": "BANTA",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "JANE",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "210-494-0504",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "TX",
            "license": "J3779",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0083TJ",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stone Oak Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Linda I Esquivel MD PA
• Linda S. Stewart
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• Guadaflor Linda Jr.
• Mary Chris Ursal Linda
• Steven Lee Lindauer, M.D.

• Dermatology Physician in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Dermatology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.