Individual
JOHN B MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
707 HOLLYBROOK DR, LONGVIEW, TX 75605-2410
(903) 753-4666
(903) 753-6634
Mailing address
PO BOX 610393, DALLAS, TX 75261-0393
(903) 232-8501
(903) 232-8226
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
H6396
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
099133305
—
TX
Enumeration date
07/03/2006
Last updated
06/13/2019
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