Individual
MR. MARK ALLEN NEUBAUER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
13601 PRESTON RD, SUITE 1000W, DALLAS, TX 75240-4911
(972) 715-5000
Mailing address
PO BOX 650426, DALLAS, TX 75265-0426
(972) 715-5007
(972) 715-5682
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
601693
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
158250405
—
TX
05
—
158250407
—
TX
01
—
85449U
BCBS
TX
01
—
P00739596
RR MEDICARE
TX
01
—
P01002879
RAILROAD MEDICARE 00607K
TX
Enumeration date
12/28/2005
Last updated
10/16/2012
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