Provider Demographics
NPI:1609877299
Name:NANCE, MURRAY F (PA-C)
Entity Type:Individual
Prefix:
First Name:MURRAY
Middle Name:F
Last Name:NANCE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 E. SONTERRA BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3987
Mailing Address - Country:US
Mailing Address - Phone:210-474-0530
Mailing Address - Fax:210-474-0532
Practice Address - Street 1:1920 E RIVERSIDE DR STE A-110
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-1348
Practice Address - Country:US
Practice Address - Phone:123-261-6005
Practice Address - Fax:123-261-6065
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11027363AM0700X
AZ2889363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ870320Medicaid
S57413Medicare UPIN
AZZ81308Medicare PIN
AZS57413Medicare UPIN
AZ870320Medicaid