MEDICARE: ROBERT JAMES THOEMKE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA00945	TX

General Provider Information

NPI Number	:	1285631093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT JAMES THOEMKE PA

Provider Business Mailing Address
First Line	:	8637 FREDERICKSBURG RD
Second Line	:	SUITE 105
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1283
Country	:	US
Telephone Number	:	210-949-4179
Fax Number	:	210-617-4075

Provider Business Practice Location Address
First Line	:	3556 FM 78
Second Line	:
City	:	MC QUEENEY
State	:	TX
Zip	:	78123-3537
Country	:	US
Telephone Number	:	830-560-2813
Fax Number	:	830-560-2812

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	01/20/2011

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