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Individual

MARK LIESER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
540 W 5TH ST, 350, ODESSA, TX 79761-5034
(432) 332-7500
(432) 332-7503
Mailing address
600 TORONTO AVE APT 18, MCALLEN, TX 78503-3071
(956) 687-7151
(956) 668-8346

Taxonomy

Speciality
Code
Description
License number
State
2086S0127X
Trauma Surgery Physician
Primary
K5142
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
118656105
TX
01
8S4850
BCBS
TX
01
P00326685
RAILROAD
TX
Enumeration date
12/11/2006
Last updated
09/11/2013
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