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General NPI Number Information
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NPI Number | 1306023049
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE INTERNAL MEDICINE PLLC
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Dates
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Enumeration Date | 01/24/2008
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Last Update Date | 01/24/2017
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Provider Practice Location Address
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Address Line | 1111 RAINTREE CIR SUITE 240
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City | ALLEN
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State | TX
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Zip | 75013-4901
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Country | US
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Telephone | 972-908-3455
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Fax | 972-908-3477
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Provider Business Mailing Address
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Address Line | 1111 RAINTREE CIR SUITE 240
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City | ALLEN
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State | TX
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Zip | 75013-4901
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Country | US
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Telephone | 972-908-3455
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Fax | 469-640-1978
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Authorized Official
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Title or Position | SOLE OWNER
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Name | DR. MARK FREDERICK DOERNER
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Credential | M.D.
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Telephone | 972-908-3455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | L8045
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License Number State | TX
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