Individual
MR. CARLTON JAY KIZZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
423 TREELINE PARK STE 325, SAN ANTONIO, TX 78209-2060
(210) 546-1460
(210) 546-1459
Mailing address
45 NE LOOP 410, STE 850, SAN ANTONIO, TX 78216-5824
(210) 805-9800
(210) 805-8770
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA03282
TX
363AS0400X
Surgical Physician Assistant
PA03282
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4016123-01
—
TX
Enumeration date
09/14/2006
Last updated
10/09/2019
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