Provider Demographics
NPI:1750438263
Name:KASZYNSKI, ERIC BERNARD III (PAC)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:BERNARD
Last Name:KASZYNSKI
Suffix:III
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 E SONTERRA BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4987
Mailing Address - Country:US
Mailing Address - Phone:210-874-3359
Mailing Address - Fax:210-874-3369
Practice Address - Street 1:1139 E SONTERRA BLVD STE 401
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4987
Practice Address - Country:US
Practice Address - Phone:210-874-3359
Practice Address - Fax:210-874-3369
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2019-0087363AM0700X
TXPA04760363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-2616977-042OtherTRICARE
TX75-2616977-043OtherTRICARE
TX286556001Medicaid
TX858N26OtherBCBS
TX8J4294OtherMEDICARE ID-TYPE UNSPECIFIED
TX75-2616977-043OtherTRICARE
TX858N26OtherBCBS
TX286556001Medicaid