Provider Demographics
NPI:1154940575
Name:RADLEY, MARYGAYLE MARTIN (DO)
Entity type:Individual
Prefix:
First Name:MARYGAYLE
Middle Name:MARTIN
Last Name:RADLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARYGAYLE
Other - Middle Name:ELIZABETH
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF PSYCHIATRY RESIDENCY PROGRAM
Mailing Address - Street 2:7703 FLOYD CURL DRIVE, MC 7792
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3900
Mailing Address - Country:US
Mailing Address - Phone:210-567-1601
Mailing Address - Fax:210-567-3483
Practice Address - Street 1:DEPARTMENT OF PSYCHIATRY RESIDENCY PROGRAM
Practice Address - Street 2:7703 FLOYD CURL DRIVE, MC 7792
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3900
Practice Address - Country:US
Practice Address - Phone:210-567-1601
Practice Address - Fax:210-567-3483
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01022069202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry