Provider Demographics
NPI:1376620401
Name:MABRY, MARY (P A)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MABRY
Suffix:
Gender:F
Credentials:P A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6710 MEADOWLAWN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77023-4014
Mailing Address - Country:US
Mailing Address - Phone:713-923-9971
Mailing Address - Fax:
Practice Address - Street 1:6710 MEADOWLAWN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77023-4014
Practice Address - Country:US
Practice Address - Phone:713-923-9971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02320363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP22307Medicare UPIN