Individual
DR. MARK D PRINCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
910 E HOUSTON ST STE 470, TYLER, TX 75702-8365
(903) 510-8718
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6400
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
35969
TN
207RG0100X
Gastroenterology Physician
Primary
P8720
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
338983501
—
TX
05
—
338983502
—
TX
01
—
75-2616977-054
TRICARE
TX
01
—
P01812747
RAIL ROAD MEDICARE
TX
Enumeration date
08/30/2005
Last updated
03/19/2024
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