MEDICARE: PRIMARY CARE MEDICAL ASSOCIATES PLLC

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
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1235988676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY CARE MEDICAL ASSOCIATES PLLC

Provider Business Mailing Address
First Line	:	9091 FAIR OAKS PKWY STE 301
Second Line	:
City	:	FAIR OAKS RANCH
State	:	TX
Zip	:	78015-4690
Country	:	US
Telephone Number	:	210-903-2002
Fax Number	:	210-429-8736

Provider Business Practice Location Address
First Line	:	9091 FAIR OAKS PKWY STE 301
Second Line	:
City	:	FAIR OAKS RANCH
State	:	TX
Zip	:	78015-4690
Country	:	US
Telephone Number	:	210-903-2002
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	REBECCA PORTER
Credential	:
Telephone Number	:	830-388-5672

Provider Enumeration Date	:	05/17/2024
Last Update Date	:	10/21/2025

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