Individual
BRANDAN CONICE BOENICKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1801 N BEDELL AVE, DEL RIO, TX 78840-8001
(830) 768-9200
Mailing address
PO BOX 437, SAN ANTONIO, TX 78292-0437
(210) 558-6288
(210) 558-6289
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA02104
TX
Other
Enumeration date
01/25/2006
Last updated
06/11/2013
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