Provider Demographics
NPI:1013599117
Name:MARSHALL, SARA CATHERINE
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:CATHERINE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 BUDDY GANEM DR STE A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-3202
Mailing Address - Country:US
Mailing Address - Phone:361-777-3900
Mailing Address - Fax:361-413-0274
Practice Address - Street 1:14249 POTRANCO RD STE 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-2132
Practice Address - Country:US
Practice Address - Phone:210-998-4811
Practice Address - Fax:210-233-8297
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TXPA14514363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant