Provider Demographics
NPI:1235183526
Name:MERCHANT-MCCAMBRY, TAMARA J (MD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:J
Last Name:MERCHANT-MCCAMBRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:621 CAMDEN ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-1612
Mailing Address - Country:US
Mailing Address - Phone:210-212-4114
Mailing Address - Fax:210-212-4012
Practice Address - Street 1:621 CAMDEN ST
Practice Address - Street 2:SUITE 150
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1612
Practice Address - Country:US
Practice Address - Phone:210-212-4114
Practice Address - Fax:210-212-4012
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM3019208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1821340-01Medicaid
TX8G6379Medicare UPIN