Healthcare Provider Details

I. General information

NPI: 1902803976
Provider Name (Legal Business Name): EDWARD MICHAEL MCCARTHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4512 VAN WINKLE DR
AMARILLO TX
79119
US

IV. Provider business mailing address

4512 VAN WINKLE DR
AMARILLO TX
79119
US

V. Phone/Fax

Practice location:
  • Phone: 806-358-1497
  • Fax: 806-358-1375
Mailing address:
  • Phone: 806-358-1497
  • Fax: 806-358-1375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberL5831
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: