Individual
AMANDA LOUISE TAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1920 CORPORATE DR STE 208, SAN MARCOS, TX 78666-6286
(512) 878-6330
(512) 878-6941
Mailing address
1920 CORPORATE DR STE 208, SAN MARCOS, TX 78666-6286
(512) 878-6330
(512) 878-6941
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
002020
IA
363A00000X
Physician Assistant
Primary
PA12794
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1A2046
MEDICARE
—
05
—
408946801
—
TX
01
—
P02466967
RR MEDICARE
—
Enumeration date
08/31/2009
Last updated
07/09/2021
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