1689963829 NPI number — MARK E MCDONNELL DPM PA

Table of content: (NPI 1689963829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689963829 NPI number — MARK E MCDONNELL DPM PA

Organization/Personal Information

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

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:
1689963829
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1340 WONDER WORLD DR
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
SAN MARCOS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78666-7598
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-878-4203
Provider Business Mailing Address Fax Number:
512-878-4209

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7900 FM 1826
Provider Second Line Business Practice Location Address:
BLDG 2, STE. 100
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78737-1407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-301-5350
Provider Business Practice Location Address Fax Number:
512-301-5395
Provider Enumeration Date:
03/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MCDONNELL
Authorized Official First Name:
MARK
Authorized Official Middle Name:
E
Authorized Official Title or Position:
DPM/PRESIDENT
Authorized Official Telephone Number:
512-301-5350

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com