Individual
MARK EPHROM SOWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
3316 N UNIVERSITY DR, SUITE C, NACOGDOCHES, TX 75965-2632
(936) 559-1700
(936) 559-1713
Mailing address
3316 N UNIVERSITY DR, SUITE C, NACOGDOCHES, TX 75965-2632
(936) 559-1700
(936) 559-1713
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
1449
TX
213ES0131X
Foot Surgery Podiatrist
1449
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0096DS
BLUE CROSS/BLUE SHIELD
TX
05
—
018599301
—
TX
01
—
4560260001
PALMETTO DMERC
TX
01
—
480029919
MEDICARE RAILROAD
TX
Enumeration date
06/15/2006
Last updated
12/14/2011
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