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NPI Code Detail

MEDICARE: TERRY LEE EMANUEL PA

MEDICARE:   TERRY LEE EMANUEL  PA
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
1363AM0700XMedical Physician AssistantPA02068TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
187N248OTHERTXMEDICARE PIN FOR GROUP 00T148

General Provider Information

NPI Number : 1093822082
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRY LEE EMANUEL PA
Provider Business Mailing Address
First Line : 8606 CHEVIOT HEIGHTS
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78212
Country : US
Telephone Number : 210-393-7553
Fax Number :
Provider Business Practice Location Address
First Line : 8606 CHEVIOT HTS
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78254-2302
Country : US
Telephone Number : 210-393-7553
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2006
Last Update Date : 04/03/2015

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Directions to “ TERRY LEE EMANUEL PA” Practice Location

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