Healthcare Provider Details

I. General information

NPI: 1700993581
Provider Name (Legal Business Name): MARY ELIZABETH PRENTICE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 BANDERA HWY STE 2
KERRVILLE TX
78028-9535
US

IV. Provider business mailing address

PO BOX 2421
BOERNE TX
78006-1400
US

V. Phone/Fax

Practice location:
  • Phone: 830-258-6237
  • Fax: 830-895-7757
Mailing address:
  • Phone: 830-214-7012
  • Fax: 830-331-2475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberK2778
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: