Individual
KIMBERLY SUE LASSWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
4360 GRECO DR, SAN ANTONIO, TX 78222-2725
(210) 648-8200
(855) 392-7988
Mailing address
1045 CENTRAL PKWY N, SUITE #200, SAN ANTONIO, TX 78232-5085
(210) 533-9591
(904) 425-2949
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA03758
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
320249102
—
TX
01
—
P01430297
RR MEDICARE
TX
01
—
PA03758
TX LICENSE
TX
Enumeration date
08/17/2009
Last updated
11/18/2016
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