Individual
DR. MARK S. SICILIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2900 E 29TH ST STE 200, BRYAN, TX 77802-2623
(979) 776-8440
(877) 601-5854
Mailing address
2900 E 29TH ST STE 100, BRYAN, TX 77802-2623
(979) 776-8440
(877) 601-5854
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
G0115
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1303125-02
—
TX
01
—
1303125-03
CSHCN
TX
05
—
130312513
—
TX
01
—
370017626
RR/MEDICARE
TX
01
—
84E416
BLUE SHIELD
TX
Enumeration date
03/31/2006
Last updated
07/15/2020
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