Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | Q0967 | TX |
N | 208200000X | Surgeon | 2007010552 | MO |
N | 208600000X | Surgeon | 2007010552 | MO |
Y | 208200000X | Surgeon | Q0967 | TX |
Y | 208600000X | Surgeon | Q0967 | TX |
NPI | 1629268321 |
---|---|
Provider Name | Dr. Malcolm Pol Macconmara |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75390-7208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2007 |
Last Update Date | 16/09/2014 |