Provider Demographics
NPI:1073510806
Name:LOTHERY, HUGH EXCELL (PA)
Entity Type:Individual
Prefix:
First Name:HUGH
Middle Name:EXCELL
Last Name:LOTHERY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8637 FREDERICKSBURG RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1283
Mailing Address - Country:US
Mailing Address - Phone:210-617-4708
Mailing Address - Fax:210-617-4075
Practice Address - Street 1:2455 NE LOOP 410
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5649
Practice Address - Country:US
Practice Address - Phone:210-599-6000
Practice Address - Fax:210-599-7519
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA00559363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P53350Medicare UPIN