Basic Information
| Provider Information | |||||||||
| NPI: | 1235405812 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURE | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | LYNNE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3989 | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785023989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563628767 | ||||||||
| FaxNumber: | 9563622548 | ||||||||
| Practice Location | |||||||||
| Address1: | 2603 MICHAELANGELO DR | ||||||||
| Address2: | |||||||||
| City: | EDINBURG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785391417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563628767 | ||||||||
| FaxNumber: | 9563623614 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2012 | ||||||||
| LastUpdateDate: | 02/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | R3159 | TX | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 370571701 | 05 | TX | MEDICAID |