MEDICARE: MARY ELIZABETH PRENTICE 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	207V00000X	Obstetrics & Gynecology Physician	K2778	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700993581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELIZABETH PRENTICE MD

Provider Business Mailing Address
First Line	:	PO BOX 2421
Second Line	:
City	:	BOERNE
State	:	TX
Zip	:	78006-1400
Country	:	US
Telephone Number	:	830-214-7012
Fax Number	:	830-331-2475

Provider Business Practice Location Address
First Line	:	1331 BANDERA HWY STE 2
Second Line	:
City	:	KERRVILLE
State	:	TX
Zip	:	78028-9535
Country	:	US
Telephone Number	:	830-258-6237
Fax Number	:	830-895-7757

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	03/07/2023

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Directions to “ MARY ELIZABETH PRENTICE MD” Practice Location

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