Individual
JOHN MARK BAYOUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2600 ALEMEDA ST STE 202, FORT WORTH, TX 76108-4042
(817) 922-9229
(949) 703-7250
Mailing address
4662 SANTA COVA CT, FORT WORTH, TX 76126-1939
(817) 371-0920
(949) 703-7250
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
K3553
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
030746404
—
TX
05
—
030746405
—
TX
01
—
030746407
MEDICAID CSHCN
TX
01
—
030746408
MEDICAID CSHCN
TX
01
—
P00265372
RAILROAD MEDICARE
—
Enumeration date
07/17/2006
Last updated
08/04/2024
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