Healthcare Provider Details

I. General information

NPI: 1992168900
Provider Name (Legal Business Name): CLINE FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4604 NE STALLINGS DR
NACOGDOCHES TX
75965-1608
US

IV. Provider business mailing address

4604 NE STALLINGS DR
NACOGDOCHES TX
75965-1608
US

V. Phone/Fax

Practice location:
  • Phone: 936-559-8770
  • Fax: 936-559-8773
Mailing address:
  • Phone: 936-559-8770
  • Fax: 936-559-8773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK A CLINE
Title or Position: OWNER
Credential: M.D.
Phone: 936-559-8770