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General NPI Number Information
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NPI Number | 1497220289
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Entity Type | Individual
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Provider Name | ANTWAIN MCGLOTHIN
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Gender | Male
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Dates
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Enumeration Date | 10/08/2018
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 3801 N LAMAR BLVD
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City | AUSTIN
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State | TX
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Zip | 78756-4080
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Country | US
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Telephone | 512-407-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 4747 RESEARCH FOREST DR STE 165
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City | SPRING
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State | TX
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Zip | 77381-4908
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Country | US
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Telephone | 512-745-0000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA14120
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License Number State | TX
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