Provider Demographics
NPI:1932325743
Name:DR. MAC'S PEDIATRICS AND ALLERGY, P.A.
Entity Type:Organization
Organization Name:DR. MAC'S PEDIATRICS AND ALLERGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCANELLY
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:972-304-9240
Mailing Address - Street 1:652 E SANDY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-3019
Mailing Address - Country:US
Mailing Address - Phone:972-304-9240
Mailing Address - Fax:972-745-3382
Practice Address - Street 1:652 E SANDY LAKE RD
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-3019
Practice Address - Country:US
Practice Address - Phone:972-304-9240
Practice Address - Fax:972-745-3382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5109208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty