Individual
MAELYN DISHMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA07934
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00889N
MEDICARE PTAN
TX
01
—
279741Y862
MEDICARE PROVIDER NUMBER
TX
Enumeration date
02/18/2013
Last updated
01/04/2024
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