Provider Demographics
NPI:1851069140
Name:SEMICH, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SEMICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14983 BOAZ LN
Mailing Address - Street 2:
Mailing Address - City:LINDALE
Mailing Address - State:TX
Mailing Address - Zip Code:75771-4801
Mailing Address - Country:US
Mailing Address - Phone:972-896-1843
Mailing Address - Fax:214-919-2560
Practice Address - Street 1:14983 BOAZ LN
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-4801
Practice Address - Country:US
Practice Address - Phone:903-530-6827
Practice Address - Fax:903-882-7748
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8042012472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology