MEDICARE: MR. GARY W PRESCOTT CO/LPO

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	1744P3200X	Prosthetics Case Management	000080	TX

General Provider Information

NPI Number	:	1457333031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY W PRESCOTT CO/LPO

Provider Business Mailing Address
First Line	:	6715 SAN PEDRO
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-7218
Country	:	US
Telephone Number	:	210-224-0726
Fax Number	:	210-341-3164

Provider Business Practice Location Address
First Line	:	6715 SAN PEDRO
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-7218
Country	:	US
Telephone Number	:	210-224-0726
Fax Number	:	210-341-3164

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	07/09/2007

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