Individual
ADDISON GRANT MARSHALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4502 MEDICAL DR, SAN ANTONIO, TX 78229
(210) 358-4000
Mailing address
4502 MEDICAL DR, SAN ANTONIO, TX 78229-4402
(210) 358-4000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA12539
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
396471001
—
TX
Enumeration date
11/20/2018
Last updated
05/24/2019
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