Active NPI 1013993096 Individual Practitioner Male Practitioner

Dr. Robert Jay Magnon , MD

Dermatology • San Antonio, TX

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Robert Magnon, MD is a certified Dermatology practicing in San Antonio, TX. With approximately 50 years of clinical experience since graduating from University Of Texas Medical Branch At Galveston in 1976, Dr. Magnon delivers high-quality medical care to the local community at 1303 MCCULLOUGH AVE.

Dr. Magnon accepts Medicare assignment.

Frequently performed procedures and clinical services include destruction of precancer skin growth, 2-14 growths, established patient outpatient office visit, destruction of skin growth. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

1303 Mccullough Ave
Suite 525

San Antonio, TX 782125609

Telephone 2102252769

Fax 2102257576

Associated Practice Facility / Clinic

🏢 John M. Mohrmann, Inc. Facility NPI 1609860725

Medicare Profile & Education

Medical School

University Of Texas Medical Branch At Galveston

Graduation Year

1976

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Dermatology in San Antonio, TX

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

50 Yrs +26.6 yrs vs City Avg

City Avg: 23.4 Yrs

State Avg: 20.2 Yrs

Regional Practice Density

107 Specialists

Practicing in San Antonio, TX (1210 Statewide)

Telehealth Adoption Rate

1.9% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

57.7% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Magnon (50 Years) 50 Yrs

San Antonio Specialty Average (23.4 Years) 23.4 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	9,828	1,068	$14.25	$6.24
99213 Established patient office or other outpatient visit, typically 15 minutes	1,927	1,089	$197.56	$86.53
17000 Destruction of skin growth	1,775	1,135	$146.25	$53.83
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	537	375	$278.64	$122.19
17110 Destruction of up to 14 skin growths	435	369	$244.21	$104.51
11102 Tangential biopsy of single skin lesion	369	318	$215.70	$83.63
17004 Destruction of precancer skin growth, 15 or more growths	348	249	$360.62	$158.07
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	222	222	$242.32	$105.43
11103 Biopsy of related skin growth, each additional growth	129	96	$107.97	$47.32
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	70	44	$2.23	$0.97
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	62	53	$385.63	$160.77
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	54	33	$31.04	$13.61
11901 Injection into skin growth, more than 7 growths	44	25	$152.17	$66.60
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	38	38	$363.92	$159.96
10061 Complicated or multiple drainage of skin abscess	36	35	$461.74	$204.36
J0702 Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg	34	22	$15.93	$6.98
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	33	30	$122.68	$53.70
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	30	29	$408.72	$178.80
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	29	27	$446.25	$195.53
10060 Simple or single drainage of skin abscess	27	27	$275.01	$116.09
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	22	20	$388.85	$166.73
11900 Injection into skin growth, 1-7 growths	21	20	$123.96	$40.12
69100 Biopsy of ear	15	14	$205.72	$66.10

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	10,196	1,042	$14.61	$6.40
99213 Established patient office or other outpatient visit, typically 15 minutes	1,851	1,043	$197.12	$86.26
17000 Destruction of skin growth	1,676	1,102	$146.60	$55.08
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	480	312	$279.29	$122.59
17004 Destruction of precancer skin growth, 15 or more growths	411	288	$369.49	$162.01
11102 Tangential biopsy of single skin lesion	368	320	$222.05	$86.23
17110 Destruction of up to 14 skin growths	282	253	$248.05	$105.57
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	243	243	$241.79	$105.66
11103 Biopsy of related skin growth, each additional growth	114	84	$110.20	$47.07
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	67	32	$2.43	$1.06
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	60	54	$387.23	$162.85
10061 Complicated or multiple drainage of skin abscess	46	41	$466.13	$200.47
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	45	41	$123.28	$54.10
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	37	32	$451.69	$189.63
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	33	21	$30.85	$13.57
11900 Injection into skin growth, 1-7 growths	32	24	$124.78	$43.63
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	26	26	$363.71	$159.74
11901 Injection into skin growth, more than 7 growths	25	12	$152.97	$61.80
10060 Simple or single drainage of skin abscess	23	22	$274.98	$120.47
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	18	18	$413.04	$176.18
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	17	17	$394.55	$172.96
69100 Biopsy of ear	16	14	$211.36	$66.54
J0702 Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg	15	11	$14.73	$6.47

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	11,477	1,115	$11.67	$6.59
99213 Established patient office or other outpatient visit, typically 15 minutes	1,935	1,141	$159.54	$87.61
17000 Destruction of skin growth	1,819	1,187	$116.96	$57.97
11102 Tangential biopsy of single skin lesion	282	250	$189.93	$94.08
17004 Destruction of precancer skin growth, 15 or more growths	278	229	$333.60	$163.77
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	265	228	$251.69	$123.84
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	237	237	$187.72	$107.63
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	227	207	$74.44	$54.27
17110 Destruction of up to 14 skin growths	182	166	$211.23	$106.39
11103 Biopsy of related skin growth, each additional growth	63	58	$94.56	$49.78
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	55	50	$348.54	$198.20
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	45	32	$28.20	$13.90
11900 Injection into skin growth, 1-7 growths	44	30	$93.18	$42.00
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	44	41	$314.27	$169.78
11106 Incision biopsy, first skin growth	41	39	$164.61	$150.90
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	40	24	$2.58	$1.13
J0702 Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg	38	27	$11.12	$6.68
10061 Complicated or multiple drainage of skin abscess	34	33	$357.11	$201.60
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	31	31	$336.46	$160.74
10060 Simple or single drainage of skin abscess	31	31	$192.34	$121.33
99202 New patient office or other outpatient visit, typically 20 minutes	28	28	$115.64	$70.71
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	21	20	$384.84	$174.38
69100 Biopsy of ear	13	13	$214.40	$83.19
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	13	13	$311.65	$175.11

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	12,471	1,107	$7.02	$6.39
17000 Destruction of skin growth	1,939	1,173	$78.10	$58.46
99213 Established patient office or other outpatient visit, typically 15 minutes	1,901	1,090	$98.72	$88.32
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	461	374	$144.61	$124.54
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	246	245	$114.84	$109.21
11102 Tangential biopsy of single skin lesion	206	194	$125.63	$96.29
11106 Incision biopsy, first skin growth	143	130	$160.28	$153.23
17004 Destruction of precancer skin growth, 15 or more growths	112	94	$179.36	$161.04
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	80	77	$59.25	$54.17
17110 Destruction of up to 14 skin growths	79	73	$120.32	$106.14
11900 Injection into skin growth, 1-7 growths	59	33	$57.59	$46.69
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	59	42	$184.49	$160.88
11103 Biopsy of related skin growth, each additional growth	53	49	$63.00	$50.81
10061 Complicated or multiple drainage of skin abscess	48	43	$215.73	$202.68
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	46	43	$241.74	$199.86
J0702 Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg	41	33	$7.00	$6.66
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	41	33	$25.00	$13.82
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	32	32	$180.00	$163.54
11107 Incision biopsy, each additional skin growth	28	23	$80.54	$71.60
10060 Simple or single drainage of skin abscess	27	27	$140.74	$116.52
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	27	25	$190.00	$178.28
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	26	24	$210.00	$172.80

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	11,729	1,088	$7.01	$5.86
99213 Established patient office or other outpatient visit, typically 15 minutes	2,026	1,173	$80.16	$72.96
17000 Destruction of skin growth	1,818	1,142	$78.06	$57.65
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	255	255	$110.00	$104.81
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	212	179	$49.98	$44.02
11102 Tangential biopsy of single skin lesion	193	179	$125.03	$94.70
11106 Incision biopsy, first skin growth	177	155	$160.06	$144.83
17004 Destruction of precancer skin growth, 15 or more growths	65	59	$160.42	$153.04
11900 Injection into skin growth, 1-7 growths	60	42	$53.20	$43.00
10061 Complicated or multiple drainage of skin abscess	47	40	$215.00	$205.45
11103 Biopsy of related skin growth, each additional growth	44	39	$63.00	$51.79
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	41	36	$240.24	$193.28
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	41	37	$180.49	$166.28
17110 Destruction of up to 14 skin growths	40	39	$120.00	$102.14
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	33	30	$25.00	$13.90
J0702 Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg	33	30	$6.78	$6.62
11107 Incision biopsy, each additional skin growth	29	26	$80.00	$70.18
99422 Online digital evaluation and management service for an established patient for up to 7 days, total time 11-20 minutes	26	21	$50.00	$28.73
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	24	24	$202.50	$160.04
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	20	20	$189.00	$169.49
10060 Simple or single drainage of skin abscess	18	18	$140.00	$115.31

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	12,543	1,270	$7.05	$5.36
99213 Established patient office or other outpatient visit, typically 15 minutes	2,389	1,372	$80.01	$71.15
17000 Destruction of skin growth	2,222	1,352	$78.16	$57.33
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	502	369	$49.59	$43.03
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	354	354	$110.42	$103.80
11102 Tangential biopsy of single skin lesion	284	269	$125.35	$91.64
11106 Incision biopsy, first skin growth	149	140	$160.88	$139.99
11900 Injection into skin growth, 1-7 growths	102	62	$53.20	$45.14
11103 Biopsy of related skin growth, each additional growth	70	65	$63.10	$50.83
17004 Destruction of precancer skin growth, 15 or more growths	70	61	$160.00	$145.66
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	64	54	$240.31	$186.81
17110 Destruction of up to 14 skin growths	57	54	$120.53	$102.08
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	52	47	$180.00	$162.67
99202 New patient office or other outpatient visit, typically 20 minutes	49	49	$83.05	$71.48
10061 Complicated or multiple drainage of skin abscess	36	33	$215.00	$199.51
10060 Simple or single drainage of skin abscess	33	31	$140.00	$114.49
J0702 Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg	32	30	$6.08	$5.99
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	32	30	$25.00	$16.00
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	26	24	$184.54	$176.33
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	21	16	$200.00	$151.99
11107 Incision biopsy, each additional skin growth	17	15	$80.00	$68.69
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	11	11	$25.00	$21.67

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	12,484	1,257	$7.00	$4.74
99213 Established patient office or other outpatient visit, typically 15 minutes	2,327	1,305	$72.14	$66.18
17000 Destruction of skin growth	2,231	1,327	$78.03	$54.78
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	607	440	$43.01	$39.64
11100 Biopsy of single growth of skin and/or tissue	435	375	$110.08	$91.14
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	316	316	$105.39	$97.33
11900 Injection into skin growth, 1-7 growths	121	63	$53.22	$44.67
11101 Biopsy of each additional growth of skin and/or tissue	98	90	$31.54	$29.73
17110 Destruction of up to 14 skin growths	73	69	$109.86	$98.18
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	58	52	$198.48	$185.67
17004 Destruction of precancer skin growth, 15 or more growths	58	51	$165.54	$129.26
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	57	49	$169.23	$149.67
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	52	46	$24.90	$18.17
J0702 Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg	52	46	$6.23	$5.91
10061 Complicated or multiple drainage of skin abscess	51	48	$200.98	$182.09
99202 New patient office or other outpatient visit, typically 20 minutes	38	38	$71.89	$68.22
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	30	28	$179.00	$166.83
10060 Simple or single drainage of skin abscess	22	21	$112.00	$105.85
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	16	16	$171.00	$157.34
17263 Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm	14	14	$185.57	$174.01
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	12	12	$20.42	$19.47

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	14,262	1,298	$7.00	$4.96
17000 Destruction of skin growth	2,415	1,385	$78.01	$54.13
99213 Established patient office or other outpatient visit, typically 15 minutes	2,310	1,320	$69.98	$65.05
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	797	561	$43.01	$38.66
11100 Biopsy of single growth of skin and/or tissue	439	380	$110.05	$87.76
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	340	340	$103.02	$96.71
11900 Injection into skin growth, 1-7 growths	100	60	$53.21	$45.06
11101 Biopsy of each additional growth of skin and/or tissue	96	89	$31.78	$28.99
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	75	66	$196.00	$180.15
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	70	54	$25.00	$22.51
J0702 Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg	70	54	$6.08	$5.98
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	60	48	$168.00	$150.32
10061 Complicated or multiple drainage of skin abscess	53	44	$201.32	$179.18
17004 Destruction of precancer skin growth, 15 or more growths	53	44	$165.65	$133.51
17110 Destruction of up to 14 skin growths	47	45	$108.89	$93.91
99202 New patient office or other outpatient visit, typically 20 minutes	45	45	$70.36	$66.36
10060 Simple or single drainage of skin abscess	40	39	$112.00	$102.73
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	23	20	$179.70	$154.83
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	23	23	$115.00	$96.97
17263 Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm	23	23	$184.61	$158.61
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	20	18	$171.00	$151.41
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	12	12	$20.00	$17.87

Medical Specialties & State Licenses

Dermatology Primary Specialty

NUCC Taxonomy Code: 207N00000X

State License TX E6134

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID

115647301 (TX)

Medicaid State Provider ID

115647302 (TX)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

4 Associated Practitioners

Kenneth Wright , PA-C

Physician Assistant

NPI 1043328834

Physician Assistant (Certified)

Dr. Kim Ross , MD

Dermatology

NPI 1184600165

Doctor of Medicine (M.D.)

Dr. Ronald Davis , MD

Dermatology

NPI 1497770572

Doctor of Medicine (M.D.)

Jenna Ruman , PA-C

Physician Assistant - Medical

NPI 1962838086

Physician Assistant (Certified)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events

✅

NPI Profile Active January 28, 2009

NPI status registered as active in NPPES database

📍

Updated Practice Location January 28, 2009

Registered at 1303 MCCULLOUGH AVE, SUITE 525, SAN ANTONIO, TX 782125609 (Tel: 2102252769)

📍

Updated Business Mailing Address January 28, 2009

Registered at 1303 MCCULLOUGH AVE, SUITE 525, SAN ANTONIO, TX 782125609 (Tel: 2102252769)

👤

Provider Name / Credentials Updated January 28, 2009

Recorded as ROBERT MAGNON, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) January 28, 2009

Dermatology (License #E6134 in TX)

🟢

Initial NPI Registration & Enumeration December 21, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1013993096

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: December 21, 2005

Last Update: January 28, 2009

Sole Proprietor: Yes

Update or Correct Profile

Mailing Address

1303 Mccullough Ave, Suite 525

San Antonio, TX 782125609

Phone: 2102252769

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

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