Provider Demographics
NPI:1285631093
Name:THOEMKE, ROBERT JAMES (PA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:THOEMKE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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:210-949-4179
Mailing Address - Fax:210-617-4075
Practice Address - Street 1:3556 FM 78
Practice Address - Street 2:
Practice Address - City:MC QUEENEY
Practice Address - State:TX
Practice Address - Zip Code:78123-3537
Practice Address - Country:US
Practice Address - Phone:830-560-2813
Practice Address - Fax:830-560-2812
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA00945363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical