Individual
AMY L MAVERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
414 NAVARRO ST, SAN ANTONIO, TX 78205-2516
(210) 579-3036
(201) 587-8167
Mailing address
PO BOX 708817, SANDY, UT 84070-8817
(801) 352-9500
(801) 352-9502
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
M3316
TX
208M00000X
Hospitalist Physician
Primary
M3316
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8V1921
BCBS
TX
01
—
P00382504
RR MEDICARE
TX
Enumeration date
06/24/2006
Last updated
04/24/2017
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