Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | MT188188 | PA |
Y | 207VX0201X | Gynecologic Oncologist | P6866 | TX |
NPI | 1548325582 |
---|---|
Provider Name | Georgia Anne-Lee Mccann |
First Address | San Antonio, TX 78229-3901 |
Second Address | San Antonio, TX 78229-3931 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 10/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
325214001 | (05) | TX |
325214002 | MEDICAID CSHCN (01) | TX |