Individual
MARK D HIATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
520 DOUGLAS BLVD, TYLER, TX 75702-8307
(903) 510-1175
(903) 510-8806
Mailing address
PO BOX 5500, TYLER, TX 75712-5500
(903) 324-6400
(903) 593-7852
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
L8075
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
175371701
—
TX
05
—
175371702
—
TX
Enumeration date
02/14/2006
Last updated
03/29/2010
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