Individual
STEPHEN L. MARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
405 LONDONDERRY DR STE 202, WACO, TX 76712-7921
(254) 772-6770
(254) 772-8471
Mailing address
405 LONDONDERRY DR STE 202, WACO, TX 76712-7921
(254) 772-6770
(254) 772-8471
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
E2703
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00R970
BLUE CROSS BLUE SHIELD
TX
Enumeration date
08/09/2006
Last updated
07/08/2007
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