Organization
BOERNE MENS CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL DAVID WAITE (MANAGER)
(469) 682-5323
Entity
Organization
Contact information
Practice address
138 TX-46, BOERNE, TX 78006
(713) 551-3455
Mailing address
138 TX 46 W, BOERNE, TX 76008-3644
(830) 446-5051
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1477547099
DR. LIVINGSTON, MD NPI
TX
Enumeration date
09/01/2020
Last updated
08/10/2021
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