Healthcare Provider Details

I. General information

NPI: 1578236824
Provider Name (Legal Business Name): MARCUS HOPKINS HALSEY III PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 07/30/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2028 SUNDANCE PKWY
NEW BRAUNFELS TX
78130-2750
US

IV. Provider business mailing address

24734 MASON TRAIL DR
KATY TX
77493-2399
US

V. Phone/Fax

Practice location:
  • Phone: 830-609-1933
  • Fax:
Mailing address:
  • Phone: 281-608-2118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA14754
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: