Individual
ANDREW MARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6720 BERTNER AVE STE MC2770, HOUSTON, TX 77030-2604
(512) 956-5229
Mailing address
122554 RIATA VISTA CIRCLE, AUSTIN, TX 78727-2611
(512) 956-5229
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
T6636
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1992152342
—
TX
Enumeration date
05/16/2016
Last updated
05/09/2023
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