Individual
MARLO MAGSANOC NICOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4502 MEDICAL DR, SAN ANTONIO, TX 78229-4402
(210) 567-4003
(210) 567-6729
Mailing address
7703 FLOYD CURL DR, MC7977, SAN ANTONIO, TX 78229-3901
(210) 450-9000
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
M1983
TX
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
M1983
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
176185003
—
TX
01
—
176185004
CSHCN
TX
Enumeration date
03/16/2006
Last updated
08/05/2011
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