Healthcare Provider Details

I. General information

NPI: 1689963829
Provider Name (Legal Business Name): MARK E MCDONNELL DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 FM 1826 BLDG 2, STE. 100
AUSTIN TX
78737-1407
US

IV. Provider business mailing address

1340 WONDER WORLD DR SUITE 104
SAN MARCOS TX
78666-7598
US

V. Phone/Fax

Practice location:
  • Phone: 512-301-5350
  • Fax: 512-301-5395
Mailing address:
  • Phone: 512-878-4203
  • Fax: 512-878-4209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MARK E MCDONNELL
Title or Position: DPM/PRESIDENT
Credential: DPM
Phone: 512-301-5350