Healthcare Provider Details

I. General information

NPI: 1184088015
Provider Name (Legal Business Name): MARK DRESSELHOUSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18780 INTERSTATE 20
CANTON TX
75103-3593
US

IV. Provider business mailing address

1500 S LAMAR BLVD APT 2008
AUSTIN TX
78704-2944
US

V. Phone/Fax

Practice location:
  • Phone: 903-567-4841
  • Fax:
Mailing address:
  • Phone: 810-287-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR6554
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: