MEDICARE: MARK E PRETORIUS MD

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	2084N0400X	Neurology Physician	F4392	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00228944	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8BL750	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1912900580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK E PRETORIUS MD

Provider Business Mailing Address
First Line	:	5201 CORINTHIAN BAY DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4028
Country	:	US
Telephone Number	:	972-596-5144
Fax Number	:	972-596-2128

Provider Business Practice Location Address
First Line	:	5201 CORINTHIAN BAY DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4028
Country	:	US
Telephone Number	:	972-596-5144
Fax Number	:	972-596-2128

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	11/05/2015

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Directions to “ MARK E PRETORIUS MD” Practice Location

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