Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 21260 | TX |
Y | 103T00000X | Psychologist | 21260 | TX |
NPI | 1013027044 |
---|---|
Provider Name | Michael J. Mcmains |
First Address | San Antonio, TX 78232-5151 |
Second Address | San Antonio, TX 78212-4804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
87217A | BLUE CROSS BLUE SHIELD (01) | TX |