Provider Demographics
NPI:1952308603
Name:MOXIN, CHARLES ALBERT (PA)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ALBERT
Last Name:MOXIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:4025 E SOUTHCROSS BLVD STE 7
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78222-3640
Mailing Address - Country:US
Mailing Address - Phone:210-333-1255
Mailing Address - Fax:210-333-8496
Practice Address - Street 1:4025 SOUTHCROSS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78222-3640
Practice Address - Country:US
Practice Address - Phone:210-333-1255
Practice Address - Fax:210-333-8496
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA00887363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P93449Medicare UPIN