Individual
ETHAN E DUBRAVSKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2130 NE LOOP 410 STE 100, SAN ANTONIO, TX 78217-4660
(210) 656-7177
(210) 656-3687
Mailing address
PO BOX 911230, DALLAS, TX 75391-1230
(972) 997-8000
(972) 234-0813
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA11118
TX
363AM0700X
Medical Physician Assistant
Primary
PA11118
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
375669402
—
TX
Enumeration date
03/29/2017
Last updated
07/15/2022
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