Individual
MARK E PRETORIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5201 CORINTHIAN BAY DR, PLANO, TX 75093-4028
(972) 596-5144
(972) 596-2128
Mailing address
5201 CORINTHIAN BAY DR, PLANO, TX 75093-4028
(972) 596-5144
(972) 596-2128
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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