Individual
MARK A WREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4613 PARKWAY DR STE 1, TEXARKANA, AR 71854-1142
(870) 330-0496
(870) 330-0499
Mailing address
4613 PARKWAY DR STE 1, TEXARKANA, AR 71854-1142
(870) 330-0496
(870) 330-0499
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
E-0509
AR
208100000X
Physical Medicine & Rehabilitation Physician
Primary
J9450
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0099KW
TEXAS B/C
TX
05
—
154623002
—
AR
05
—
1687311-01
—
TX
01
—
97112
B/C ARKANSAS
AR
01
—
E-0509
LICENSE
AR
01
—
J9450
TEXAS LICENSE
TX
Enumeration date
05/03/2006
Last updated
04/18/2024
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