Individual
MARK W. GREENWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
635 STONE AVE, PARIS, TX 75460-9342
(903) 785-3300
(903) 785-3310
Mailing address
1133 MEDICAL DR, TYLER, TX 75701-2130
(903) 595-5486
(903) 595-5128
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
29498
OK
207RN0300X
Nephrology Physician
Primary
P3725
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200452580 A
—
OK
05
—
3058059-01
—
TX
Enumeration date
05/01/2006
Last updated
04/20/2023
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