MEDICARE: MARJORIE MUCKLEY SCOGIN PA-C

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	363A00000X	Physician Assistant	PA02014	TX

General Provider Information

NPI Number	:	1689661670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARJORIE MUCKLEY SCOGIN PA-C

Provider Business Mailing Address
First Line	:	2961 MOSSROCK
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-5119
Country	:	US
Telephone Number	:	210-731-4800
Fax Number	:

Provider Business Practice Location Address
First Line	:	6428 BANDERA RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-1511
Country	:	US
Telephone Number	:	210-520-4455
Fax Number	:	210-520-4421

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	07/15/2025

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