Individual
DR. EMMETT R. MACKAN II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
755 N 11TH ST STE P3950, BEAUMONT, TX 77702-1527
(409) 892-0099
(409) 892-1911
Mailing address
755 N 11TH ST STE P3950, BEAUMONT, TX 77702-1527
(409) 892-0099
(409) 892-1911
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
H2553
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127855801
—
TX
01
—
2847607001
CIGNA
TX
01
—
4365640
AETNA
TX
01
—
82X590
BLUECROSSBLUESHIELD
TX
Enumeration date
06/13/2005
Last updated
03/17/2018
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