Basic Information
| Provider Information | |||||||||
| NPI: | 1013599117 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARSHALL | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | CATHERINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 277 BUDDY GANEM DR STE A | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 783743202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3617773900 | ||||||||
| FaxNumber: | 3614130274 | ||||||||
| Practice Location | |||||||||
| Address1: | 14249 POTRANCO RD STE 102 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782532132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109984811 | ||||||||
| FaxNumber: | 2102338297 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2021 | ||||||||
| LastUpdateDate: | 09/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA14514 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.