Individual
MARK E PRETORIUS
Active
Individual
MARK E PRETORIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
F4392
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122894205
—
TX
01
—
8BL750
BCBS
TX
01
—
P00228944
RAILROAD MEDICARE
TX
Enumeration date
05/27/2005
Last updated
11/05/2015
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