Healthcare Provider Details

I. General information

NPI: 1750392270
Provider Name (Legal Business Name): GORDON ADAMS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 CASTROVILLE RD
SAN ANTONIO TX
78207-5147
US

IV. Provider business mailing address

448 CASTROVILLE RD
SAN ANTONIO TX
78207-5147
US

V. Phone/Fax

Practice location:
  • Phone: 210-434-1400
  • Fax: 210-431-7472
Mailing address:
  • Phone: 210-434-1400
  • Fax: 210-431-7472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA04305
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: