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Organization
PERIPHERAL VASCULAR ASSOCIATES, P.A.
Active
Organization
PERIPHERAL VASCULAR ASSOCIATES, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PHYLLIS B. DAVENPORT (ADMINISTRATOR)
(210) 237-4492
Entity
Organization
Contact information
Practice address
610 NORTH MAIN AVENUE, 2ND FLOOR, SAN ANTONIO, TX 78205-1204
(210) 237-4492
(210) 828-0590
Mailing address
610 NORTH MAIN, SECOND FLOOR, SAN ANTONIO, TX 78205-1204
(210) 237-4492
(210) 828-0590
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
—
NULL
207RI0011X
Interventional Cardiology Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
—
—
208600000X
Surgery Physician
—
NULL
208600000X
Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
Primary
—
NULL
2086S0129X
Vascular Surgery Physician
Primary
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
NULL
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
224P00000X
Prosthetist
—
NULL
224P00000X
Prosthetist
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
363LA2100X
Acute Care Nurse Practitioner
—
NULL
363LA2100X
Acute Care Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
—
NULL
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
05/26/2006
Last updated
07/21/2023
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