Provider Demographics
NPI:1477639664
Name:PAULI, ISHAM WALKER JR (MD)
Entity Type:Individual
Prefix:MR
First Name:ISHAM
Middle Name:WALKER
Last Name:PAULI
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:8606 VILLAGE DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217
Mailing Address - Country:US
Mailing Address - Phone:210-657-0220
Mailing Address - Fax:210-590-7288
Practice Address - Street 1:18707 HARDY OAK BLVD
Practice Address - Street 2:STE 225
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4869
Practice Address - Country:US
Practice Address - Phone:210-657-0220
Practice Address - Fax:210-402-2868
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2017-10-11
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Provider Licenses
StateLicense IDTaxonomies
TXK3386208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046787001Medicaid
TX046787001Medicaid
TX888529Medicare ID - Type Unspecified