Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | J1559 | TX |
Y | 207ND0101X | MOHS-Micrographic Surgeon | J1559 | TX |
N | 207NS0135X | Procedural Dermatology | J1559 | TX |
NPI | 1104985407 |
---|---|
Provider Name | Mark A Price |
First Address | Houston, TX 77004-7018 |
Second Address | Houston, TX 77004-7018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 08/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G06246 | (02) |