Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 66967 | GA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 036132737 | IL |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | R1630 | TX |
NPI | 1093036329 |
---|---|
Provider Name | Paul Michalovich Royal-Priest |
First Address | San Antonio, TX 78251-4766 |
Second Address | Jbsa Ft Sam Houston, TX 78234-4504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2010 |
Last Update Date | 17/03/2020 |