MEDICARE: MR. MIGUEL EUGENIO MACIAS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA 01007	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	T0130567	OTHER	TX	DPS NUMBER

General Provider Information

NPI Number	:	1306848882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MIGUEL EUGENIO MACIAS PA

Provider Business Mailing Address
First Line	:	7055 BANDERA RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-1266
Country	:	US
Telephone Number	:	210-281-5585
Fax Number	:	210-281-4498

Provider Business Practice Location Address
First Line	:	7055 BANDERA RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-1266
Country	:	US
Telephone Number	:	210-281-5585
Fax Number	:	210-281-4498

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2005
Last Update Date	:	06/06/2025

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