Active NPI
Levon Clark Sr., PA
- Physician Assistant
- San Antonio, TX
National Provider Identifier
1508951435
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA02702
- Practice address
- 5788 Eckhert Rd
San Antonio, TX 78240-3900 - Phone
- (210) 699-2280
- Fax
- (210) 699-2250
- NPI assigned
- Oct 4, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA02702 | TX | Primary |
Addresses
Primary practice location
5788 Eckhert Rd
San Antonio, TX 78240-3900
Mailing address
5788 Eckhert Rd
San Antonio, TX 78240-3900
Phone (210) 699-2280
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA02702 | TX | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508951435",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5788 ECKHERT RD",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782403900",
"telephone_number": "210-699-2280",
"fax_number": "210-699-2250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5788 ECKHERT RD",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782403900",
"telephone_number": "210-699-2280",
"fax_number": "210-699-2250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "LEVON",
"name_prefix": "Mr.",
"name_suffix": "Sr.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA02702",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.