Provider Demographics
NPI:1124163811
Name:MAHAFFEY, MCDAVID M (MD)
Entity type:Individual
Prefix:DR
First Name:MCDAVID
Middle Name:M
Last Name:MAHAFFEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-3816
Mailing Address - Country:US
Mailing Address - Phone:817-202-3976
Mailing Address - Fax:817-202-3978
Practice Address - Street 1:805 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-3816
Practice Address - Country:US
Practice Address - Phone:817-202-3976
Practice Address - Fax:817-202-3978
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9473207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1V2362OtherMEDICARE NUMBER
TXM9473OtherTEXAS LICENSE NUMBER