Individual
CHARLES WALBOURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3200 AVENUE E, HONDO, TX 78861
(830) 426-7444
(830) 426-7468
Mailing address
3200 AVENUE E, HONDO, TX 78861
(830) 426-7444
(830) 426-7468
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00820
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8G3322
BLUECROSS
TX
01
—
8J0362
BLUECROSS
TX
01
—
8K5352
BLUECROSS
TX
Enumeration date
03/20/2007
Last updated
07/08/2007
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