Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Charles Mark Russell, PA

Individual provider Medical Physician Assistant · NPI 1043218720

Charles Mark Russell, PA is a Medical Physician Assistant in San Antonio, Texas. Licensed in Texas. Registered with an NPI since 2005.

Licensed in
TX
In the registry since
2005
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

6157 NW Loop 410 Ste 124
San Antonio, TX 78238-3302
Phone: (210) 523-1411
Fax: (210) 523-9307
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence PA00353 (TX)

Record details

NPI number1043218720
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedJuly 7, 2005
Last updated in NPPESOctober 18, 2016

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