Provider Demographics
NPI:1306541024
Name:MAIRSON, THERESA MCALISTER (MD)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:MCALISTER
Last Name:MAIRSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:MCALISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7143 HIGH DR
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VLG
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3354
Mailing Address - Country:US
Mailing Address - Phone:913-909-4219
Mailing Address - Fax:
Practice Address - Street 1:59MDW/GE 1100 WILFORD HALL LOOP
Practice Address - Street 2:BLDG 4554
Practice Address - City:JBSA-LACKLAND
Practice Address - State:TX
Practice Address - Zip Code:78236-7823
Practice Address - Country:US
Practice Address - Phone:913-909-4219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider