Provider Demographics
NPI:1518917319
Name:DUNGAN, SARA MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:MARIE
Last Name:DUNGAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:MARIE
Other - Last Name:WISKOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, ATC
Mailing Address - Street 1:8122 DATAPOINT DR STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3264
Mailing Address - Country:US
Mailing Address - Phone:210-998-6900
Mailing Address - Fax:210-998-6907
Practice Address - Street 1:8122 DATAPOINT DR STE 120
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3264
Practice Address - Country:US
Practice Address - Phone:210-998-6900
Practice Address - Fax:210-998-6907
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2022-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055572363A00000X
TXPA09521363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1084918OtherNCCPA PHYSICIAN ASSISTANT