Provider Demographics
NPI:1407858780
Name:MCAFEE, WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:
Last Name:MCAFEE
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 1:100 MEDICAL CENTER BLVD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2821
Mailing Address - Country:US
Mailing Address - Phone:936-321-7733
Mailing Address - Fax:936-273-7722
Practice Address - Street 1:100 MEDICAL CENTER BLVD.
Practice Address - Street 2:SUITE 100
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2821
Practice Address - Country:US
Practice Address - Phone:936-321-7733
Practice Address - Fax:936-273-7722
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD0222174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0841082-01Medicaid
TX803936Medicare ID - Type Unspecified
TX0841082-01Medicaid