MEDICARE: DR. DAVID ROSS MACK 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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	J0085	TX
2	207X00000X	Orthopaedic Surgery Physician	J0085	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8F4302	OTHER	TX	BC/BS

General Provider Information

NPI Number	:	1922054063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID ROSS MACK M.D.

Provider Business Mailing Address
First Line	:	11800 FM 1960 RD W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-3840
Country	:	US
Telephone Number	:	281-664-2107
Fax Number	:	281-955-5875

Provider Business Practice Location Address
First Line	:	10425 HUFFMEISTER RD STE 320
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-3429
Country	:	US
Telephone Number	:	281-955-2650
Fax Number	:	281-955-5875

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	05/20/2022

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