Healthcare Provider Details

I. General information

NPI: 1609848241
Provider Name (Legal Business Name): MARK W PAPE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 WESTOVER RD SUITE 7
LACKLAND A F B TX
78236-0121
US

IV. Provider business mailing address

1422 MACKENZIE ST
SAN ANGELO TX
76901-4632
US

V. Phone/Fax

Practice location:
  • Phone: 210-925-7188
  • Fax: 210-925-0199
Mailing address:
  • Phone: 325-653-0521
  • Fax: 325-942-2548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number1027472
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: