Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2859 | TX |
NPI | 1003887548 |
---|---|
Provider Name | Dr. Mark Richard Hembree |
First Address | Tyler, TX 75703-4406 |
Second Address | Tyler, TX 75703-4406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 04/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001161102 | (05) | TX |
8R6370 | BCBS OF TEXAS (01) | TX |
T13774 | (02) | TX |