1578965869 NPI number — MARK E TUGGLE

Table of content: MARK E TUGGLE (NPI 1578965869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578965869 NPI number — MARK E TUGGLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TUGGLE
Provider First Name:
MARK
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578965869
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4401 LONG PRAIRIE RD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
FLOWER MOUND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75028-1794
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-691-1331
Provider Business Mailing Address Fax Number:
972-691-1731

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4401 LONG PRAIRIE RD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
FLOWER MOUND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75028-1794
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-691-1331
Provider Business Practice Location Address Fax Number:
972-691-1731
Provider Enumeration Date:
09/18/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1242407 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)