Healthcare Provider Details

I. General information

NPI: 1922054063
Provider Name (Legal Business Name): DAVID ROSS MACK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 05/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10425 HUFFMEISTER RD STE 320
HOUSTON TX
77065-3429
US

IV. Provider business mailing address

11800 FM 1960 RD W
HOUSTON TX
77065-3840
US

V. Phone/Fax

Practice location:
  • Phone: 281-955-2650
  • Fax: 281-955-5875
Mailing address:
  • Phone: 281-664-2107
  • Fax: 281-955-5875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberJ0085
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberJ0085
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: