Unknown Individual – Physician Assistant, NPI 1255503579
Physician Assistant
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Unknown Individual
1222 MCCULLOUGH AVE
SUITE 101
SAN ANTONIO, TX 782124812
Phone: (201) 223-4140
Fax: (210) 223-4165
Type: Location
15000, Northwest Military Highway, Shavano Park, Bexar County, Texas, 78231, United States
SHAVANO PARK, TX 782311525
Phone: (210) 379-8666
Fax: (210) 223-4165
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 78212)
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