Healthcare Provider Details

I. General information

NPI: 1841284668
Provider Name (Legal Business Name): MARK B CUA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 HEART DRIVE
BROWNSVILLE TX
78520
US

IV. Provider business mailing address

213 HEART DRIVE
BROWNSVILLE TX
78520
US

V. Phone/Fax

Practice location:
  • Phone: 956-504-3278
  • Fax: 956-504-3287
Mailing address:
  • Phone: 956-504-3278
  • Fax: 956-504-3287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberK6831
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: