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General NPI Number Information
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NPI Number | 1538175443
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Entity Type | Individual
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Provider Name | MARSHALL BRANDON PACKARD MD
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 04/03/2018
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Provider Practice Location Address
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Address Line | 414 NAVARRO ST STE 502
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City | SAN ANTONIO
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State | TX
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Zip | 78205-2580
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Country | US
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Telephone | 210-223-1145
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Fax | 210-615-7619
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Provider Business Mailing Address
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Address Line | 11844 BANDERA RD PMB 452
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City | HELOTES
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State | TX
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Zip | 78023-4132
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Country | US
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Telephone | 210-223-1145
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Fax | 210-615-7619
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | L1419
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2083P0011X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
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License Number | L1419
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License Number State | TX
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