MEDICARE: DR. MARK ALLEN DOSMANN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician	J5088	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00177045	OTHER	AL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	051524274	OTHER	AL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1245376219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ALLEN DOSMANN M.D.

Provider Business Mailing Address
First Line	:	17423 RANCHO DIANA
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78255-3365
Country	:	US
Telephone Number	:	210-239-5551
Fax Number	:

Provider Business Practice Location Address
First Line	:	17423 RANCHO DIANA
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78255-3365
Country	:	US
Telephone Number	:	210-239-5551
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	03/26/2023

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Directions to “ DR. MARK ALLEN DOSMANN M.D.” Practice Location

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