Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 12624 | TX |
NPI | 1396149084 |
---|---|
Provider Name | Dr. James Leonard Macie |
First Address | San Antonio, TX 78232-1906 |
Second Address | San Antonio, TX 78232-1906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2014 |
Last Update Date | 09/10/2014 |