=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164751830
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARK VANN MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2009
-----------------------------------------------------
Last Update Date | 07/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7789 SOUTHWEST FWY SUITE 410
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77074-1834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-876-6518
-----------------------------------------------------
Fax | 832-623-6236
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 60
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77406-0002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-876-6518
-----------------------------------------------------
Fax | 832-623-6236
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MARK ANTHONY VANN II
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 202-746-9044
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | M9069
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------