Basic Information
Provider Information
NPI: 1629520499
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HUEY
FirstName: ADRIAN
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 315 N SAN SABA
Address2: SUITE 1135
City: SAN ANTONIO
State: TX
PostalCode: 782073154
CountryCode: US
TelephoneNumber: 2107043030
FaxNumber:  
Practice Location
Address1: 333 N SANTA ROSA ST
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782073108
CountryCode: US
TelephoneNumber: 2107043030
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/27/2016
LastUpdateDate: 10/27/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700XPA10736TXY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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