Individual
MARK FASULO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
755 N 11TH ST, P2200, BEAUMONT, TX 77702-1513
(409) 892-1192
Mailing address
755 N 11TH ST, SUITE P2200, BEAUMONT, TX 77702-1500
(409) 892-1192
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
M9273
TX
207RC0000X
Cardiovascular Disease Physician
Primary
M9273
TX
Other
Enumeration date
04/21/2009
Last updated
03/28/2019
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