MEDICARE: GARY MARTIN MAILMAN MD

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	207PE0005X	Undersea and Hyperbaric Medicine (Emergency Medicine) Physician	J9186	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10015657	OTHER	TX	AMERIGROUP
2	87Y621	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205822558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY MARTIN MAILMAN MD

Provider Business Mailing Address
First Line	:	PO BOX 4268
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78765-4268
Country	:	US
Telephone Number	:	512-306-1903
Fax Number	:	512-551-9295

Provider Business Practice Location Address
First Line	:	4316 JAMES CASEY ST
Second Line	:	SUITE B 100
City	:	AUSTIN
State	:	TX
Zip	:	78745-1116
Country	:	US
Telephone Number	:	512-306-1903
Fax Number	:	512-551-9295

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

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	04/28/2015

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