Provider Demographics
NPI:1629080726
Name:STEIN, MARYRAE R (PA)
Entity Type:Individual
Prefix:
First Name:MARYRAE
Middle Name:R
Last Name:STEIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3706 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7046
Mailing Address - Country:US
Mailing Address - Phone:512-324-4973
Mailing Address - Fax:512-324-4948
Practice Address - Street 1:3706 S 1ST ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7046
Practice Address - Country:US
Practice Address - Phone:512-324-4973
Practice Address - Fax:512-324-4948
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00803363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP36589Medicare UPIN
TX86N239Medicare ID - Type Unspecified