Provider Demographics
NPI:1780833905
Name:R. KARL MAHAFFEY, MD P.A.
Entity Type:Organization
Organization Name:R. KARL MAHAFFEY, MD P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KARL
Authorized Official - Last Name:MAHAFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-293-9332
Mailing Address - Street 1:2507 LAKE RD
Mailing Address - Street 2:A
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-5756
Mailing Address - Country:US
Mailing Address - Phone:936-436-9098
Mailing Address - Fax:936-439-9098
Practice Address - Street 1:2507 LAKE RD
Practice Address - Street 2:A
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-5756
Practice Address - Country:US
Practice Address - Phone:936-436-9098
Practice Address - Fax:936-439-9098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4495207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A0348Medicare PIN