Individual
MARK O DAMMERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1180 SETON PKWY, SUITE 420, KYLE, TX 78640-6178
(512) 268-5282
(512) 268-5769
Mailing address
1180 SETON PKWY, SUITE 420, KYLE, TX 78640-6178
(512) 268-5282
(512) 268-5769
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
N9533
TX
207YS0123X
Facial Plastic Surgery Physician
N9533
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
288309202
—
TX
05
—
288309203
—
TX
01
—
8DY645
BCBS
TX
Enumeration date
05/24/2007
Last updated
01/06/2014
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