Healthcare Provider Details

I. General information

NPI: 1497230593
Provider Name (Legal Business Name): JAMES ANDREW VARNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12702 N IH 35
LIVE OAK TX
78233-2609
US

IV. Provider business mailing address

12702 N IH 35
LIVE OAK TX
78233-2609
US

V. Phone/Fax

Practice location:
  • Phone: 210-650-9669
  • Fax: 210-654-1432
Mailing address:
  • Phone: 210-650-9669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA12231
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA12231
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: