Provider Demographics
NPI:1972606291
Name:MCINTYRE, DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 MARATHON BLVD
Mailing Address - Street 2:#201
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3436
Mailing Address - Country:US
Mailing Address - Phone:512-454-6765
Mailing Address - Fax:512-467-1483
Practice Address - Street 1:4201 MARATHON BLVD
Practice Address - Street 2:#201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3436
Practice Address - Country:US
Practice Address - Phone:512-454-6765
Practice Address - Fax:512-467-1483
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6509207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000AK63Medicare ID - Type Unspecified
TXC19162Medicare UPIN