Provider Demographics
NPI:1326128471
Name:MCCAMISH, SARA D (MD)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:D
Last Name:MCCAMISH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4125 MCCULLOUGH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-1903
Mailing Address - Country:US
Mailing Address - Phone:210-826-2822
Mailing Address - Fax:210-826-1621
Practice Address - Street 1:4125 MCCULLOUGH AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-1903
Practice Address - Country:US
Practice Address - Phone:210-826-2822
Practice Address - Fax:210-826-1621
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7478207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH71209Medicare UPIN
TX8DO965Medicare ID - Type Unspecified