Basic Information
| Provider Information | |||||||||
| NPI: | 1184613242 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TROY | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1355 CENTRAL PKWY S | ||||||||
| Address2: | STE 400 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782325057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103499300 | ||||||||
| FaxNumber: | 2103662558 | ||||||||
| Practice Location | |||||||||
| Address1: | 1303 MCCULLOUGH AVE | ||||||||
| Address2: | SUITE GL70 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782125631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102269705 | ||||||||
| FaxNumber: | 2102234555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2005 | ||||||||
| LastUpdateDate: | 01/28/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | J2993 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 105543603 | 05 | TX | MEDICAID |