Provider Demographics
NPI:1093036329
Name:ROYAL-PRIEST, PAUL MICHALOVICH
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:MICHALOVICH
Last Name:ROYAL-PRIEST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10010 ROGERS XING STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4766
Mailing Address - Country:US
Mailing Address - Phone:210-539-0943
Mailing Address - Fax:
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:JBSA FT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-539-0943
Practice Address - Fax:210-521-2577
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA66967207Q00000X
IL036132737207QG0300X
TXR1630207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine