Provider Demographics
NPI:1366477481
Name:MACIAS, VINCENT R (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:R
Last Name:MACIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 E ESPERANZA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-1402
Mailing Address - Country:US
Mailing Address - Phone:956-686-2920
Mailing Address - Fax:956-686-2685
Practice Address - Street 1:725 E ESPERANZA AVE STE A
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-1402
Practice Address - Country:US
Practice Address - Phone:956-686-2920
Practice Address - Fax:956-686-2685
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9768207SG0201X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153910802Medicaid
TXG9868OtherMEDICAL LICENSE
TXG9868OtherMEDICAL LICENSE