Healthcare Provider Details

I. General information

NPI: 1346274610
Provider Name (Legal Business Name): MARK ALLEN FEIST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 24TH ST SUITE 401
LUBBOCK TX
79410-1806
US

IV. Provider business mailing address

PO BOX 733784
DALLAS TX
75373-3784
US

V. Phone/Fax

Practice location:
  • Phone: 806-725-5830
  • Fax: 806-796-6131
Mailing address:
  • Phone: 682-885-6483
  • Fax: 682-886-3113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberM3538
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: