Individual
MARSHALL BRANDON PACKARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
414 NAVARRO ST STE 502, SAN ANTONIO, TX 78205-2580
(210) 223-1145
(210) 615-7619
Mailing address
11844 BANDERA RD, PMB 452, HELOTES, TX 78023-4132
(210) 223-1145
(210) 615-7619
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
L1419
TX
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
Primary
L1419
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148874414
—
TX
01
—
529251ZWH7
MEDICARE PTAN
—
01
—
8EE324
BCBS ID
TX
Enumeration date
07/31/2006
Last updated
04/03/2018
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