Provider Demographics
NPI:1548456734
Name:CROWDER, GINGER (PA)
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:
Last Name:CROWDER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29130
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-0130
Mailing Address - Country:US
Mailing Address - Phone:210-692-1181
Mailing Address - Fax:210-692-7584
Practice Address - Street 1:9635 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1512
Practice Address - Country:US
Practice Address - Phone:210-692-1181
Practice Address - Fax:210-692-7584
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTEMPORARY2086S0122X
TXPA05453363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery