Provider Demographics
NPI:1801892930
Name:MACRIS, DEMETRIOS N (MD)
Entity type:Individual
Prefix:DR
First Name:DEMETRIOS
Middle Name:N
Last Name:MACRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:718 LEXINGTON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4790
Mailing Address - Country:US
Mailing Address - Phone:210-420-8671
Mailing Address - Fax:210-899-1958
Practice Address - Street 1:718 LEXINGTON AVENUE, SUITE 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4678
Practice Address - Country:US
Practice Address - Phone:210-420-8671
Practice Address - Fax:210-899-1958
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ2667208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102130501Medicaid
TXF32406Medicare UPIN
TX102130501Medicaid