MEDICARE: MRS. ALLISON LEIGH TEAGUE PA-C

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	363A00000X	Physician Assistant	PA17766	TX

General Provider Information

NPI Number	:	1932862208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALLISON LEIGH TEAGUE PA-C

Provider Business Mailing Address
First Line	:	3320 OAKWELL CT
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-3128
Country	:	US
Telephone Number	:	210-829-5180
Fax Number	:	210-829-5030

Provider Business Practice Location Address
First Line	:	21727 IH 10 W FL 2
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-2106
Country	:	US
Telephone Number	:	210-829-5180
Fax Number	:	210-829-5030

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

Provider Enumeration Date	:	10/14/2021
Last Update Date	:	03/05/2026

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