Provider Demographics
NPI:1366770802
Name:WASSNER, ERIC J (LSA)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:J
Last Name:WASSNER
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18827 CANYON VIEW PASS
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-2879
Mailing Address - Country:US
Mailing Address - Phone:210-391-4324
Mailing Address - Fax:
Practice Address - Street 1:18827 CANYON VIEW PASS
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-2879
Practice Address - Country:US
Practice Address - Phone:210-391-4324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSA00495OtherTEXAS STATE LICENSE