Provider Demographics
NPI:1982107124
Name:MCALLISTER, PHILLIP RICHARD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:RICHARD
Last Name:MCALLISTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7835 W IH 10
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-4779
Mailing Address - Country:US
Mailing Address - Phone:210-614-4405
Mailing Address - Fax:210-614-7892
Practice Address - Street 1:7835 W IH 10
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-4779
Practice Address - Country:US
Practice Address - Phone:210-614-4405
Practice Address - Fax:210-614-7892
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA11876363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical