Individual
MARY ELLEN MCINTIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
111 W CEDAR LN STE A, PAYSON, AZ 85541-5417
(928) 472-4675
(928) 472-3431
Mailing address
111 W CEDAR LN STE A, PAYSON, AZ 85541-5417
(928) 472-4675
(928) 472-3431
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
47600
AZ
208D00000X
General Practice Physician
36832
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31273
TLC
TN
05
—
3891205
—
TN
05
—
863437
—
AZ
01
—
P00183551
RAILROAD MEDICARE
TN
Enumeration date
07/04/2006
Last updated
10/03/2015
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