Provider Demographics
NPI:1457322208
Name:MABRY, PAUL ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ALAN
Last Name:MABRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:809 GALLAGHER DR STE D
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-1754
Mailing Address - Country:US
Mailing Address - Phone:903-771-2846
Mailing Address - Fax:037-712-8499
Practice Address - Street 1:809 GALLAGHER DR STE D
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-1754
Practice Address - Country:US
Practice Address - Phone:903-771-2846
Practice Address - Fax:037-712-8499
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2549207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM01629432Medicaid
NYG23103Medicare UPIN