Provider Demographics
NPI:1851374623
Name:MACGILLIVRAY, BRIAN K (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:K
Last Name:MACGILLIVRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20658 STONE OAK PKWY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7344
Mailing Address - Country:US
Mailing Address - Phone:210-447-9275
Mailing Address - Fax:210-447-9279
Practice Address - Street 1:20658 STONE OAK PKWY
Practice Address - Street 2:SUITE 108
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7344
Practice Address - Country:US
Practice Address - Phone:210-447-9275
Practice Address - Fax:210-447-9279
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-25
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3304207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AH273OtherBCBS
TX179874604Medicaid
TX8L1006Medicare PIN
TX179874604Medicaid