Provider Demographics
NPI:1780674168
Name:MACKEY, EVA M (MD)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:M
Last Name:MACKEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EVA
Other - Middle Name:M
Other - Last Name:MEYRAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1575 I 30
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6905
Mailing Address - Country:US
Mailing Address - Phone:469-800-2800
Mailing Address - Fax:469-800-2801
Practice Address - Street 1:1575 I 30
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6905
Practice Address - Country:US
Practice Address - Phone:469-800-2800
Practice Address - Fax:469-800-2801
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8815207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8G9990Medicare PIN
TXI22828Medicare UPIN