Provider Demographics
NPI:1790223568
Name:LEDOUX, MICHAEL ROBERT (PA-C)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:LEDOUX
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:400 CONCORD PLAZA DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6905
Mailing Address - Country:US
Mailing Address - Phone:210-804-5416
Mailing Address - Fax:210-678-4142
Practice Address - Street 1:2829 BABCOCK RD
Practice Address - Street 2:SUITE 700
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6028
Practice Address - Country:US
Practice Address - Phone:210-593-1485
Practice Address - Fax:210-804-5418
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
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Provider Licenses
StateLicense IDTaxonomies
TXPA10969363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA10969OtherTEXAS MEDICAL BOARD