Individual
MS. MARY CATHERINE GRACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1900 N MAIN AVE, SAN ANTONIO, TX 78212-3942
(210) 226-3204
(210) 226-2854
Mailing address
2455 NE LOOP 410, STE 100, SAN ANTONIO, TX 78217-5649
(210) 599-6000
(210) 657-5586
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA00293
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
312816701
WELLMED MEDICAID
TX
01
—
TXB159554
WELLMED MEDICAL GROUP PA
—
Enumeration date
07/07/2005
Last updated
03/10/2023
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