Individual
MARK G POAG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12554 RIATA VISTA CIR, AUSTIN, TX 78727-6431
(512) 795-5100
(512) 795-5122
Mailing address
12554 RIATA VISTA CIR, AUSTIN, TX 78727-6431
(512) 795-5100
(512) 795-5122
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
4301056212
MI
2085R0202X
Diagnostic Radiology Physician
Primary
G5489
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
039376102
—
TX
05
—
2794238
—
MI
Enumeration date
01/28/2006
Last updated
02/23/2018
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