MEDICARE: THERESA MCALISTER MAIRSON M.D.

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	208D00000X	General Practice Physician	0101286696	VA

General Provider Information

NPI Number	:	1306541024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA MCALISTER MAIRSON M.D.

Provider Business Mailing Address
First Line	:	5788 ECKHERT RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-3900
Country	:	US
Telephone Number	:	210-450-6450
Fax Number	:

Provider Business Practice Location Address
First Line	:	59MDW/GE 1100 WILFORD HALL LOOP
Second Line	:	BLDG 4554
City	:	JBSA-LACKLAND
State	:	TX
Zip	:	78236-7823
Country	:	US
Telephone Number	:	913-909-4219
Fax Number	:

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

Provider Enumeration Date	:	04/03/2023
Last Update Date	:	03/21/2026

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