Provider Demographics
NPI:1962646075
Name:MCGILL, DAPHNE ROXANNE (IDMT)
Entity Type:Individual
Prefix:MRS
First Name:DAPHNE
Middle Name:ROXANNE
Last Name:MCGILL
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 QUENTIN ROOSEVELT RD STE 2
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78226-2017
Mailing Address - Country:US
Mailing Address - Phone:210-925-1175
Mailing Address - Fax:
Practice Address - Street 1:485 QUENTIN ROOSEVELT RD STE 2
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78226-2017
Practice Address - Country:US
Practice Address - Phone:210-925-1175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians