Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | J3154 | TX |
Y | 208000000X | Pediatrician | J3154 | TX |
NPI | 1669415642 |
---|---|
Provider Name | Dr. Gerald Thomas Mayer |
First Address | San Antonio, TX 78260-5933 |
Second Address | San Antonio, TX 78258-3456 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 22/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D04250 | (02) |