Provider Demographics
NPI:1972500098
Name:MIESCH, MARY GAIL (MD, FACOG)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:GAIL
Last Name:MIESCH
Suffix:
Gender:F
Credentials:MD, FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 S COLLEGIATE DR
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-6307
Mailing Address - Country:US
Mailing Address - Phone:903-784-1141
Mailing Address - Fax:903-784-6198
Practice Address - Street 1:945 S COLLEGIATE DR
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-6307
Practice Address - Country:US
Practice Address - Phone:903-784-1141
Practice Address - Fax:903-784-6198
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7081207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE66035Medicare UPIN
TX00R32LMedicare ID - Type UnspecifiedMEDICARE