Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | J5312 | TX |
NPI | 1043389141 |
---|---|
Provider Name | Dr. Mark Christopher Drew |
First Address | Dallas, TX 75284-0026 |
Second Address | Amarillo, TX 79106-1781 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 19/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
124880907 | (05) | TX |