Individual
MARK A TILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8200 WALNUT HILL LN, DALLAS, TX 75231-4426
(214) 345-6789
Mailing address
PO BOX 8549, FORT WORTH, TX 76124-0549
(817) 451-4208
(817) 563-3699
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
G5692
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0086DN
BCBS
TX
Enumeration date
06/14/2006
Last updated
02/05/2008
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