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General NPI Number Information
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NPI Number | 1427043967
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Entity Type | Individual
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Provider Name | MARK MENEFEE METTAUER M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/12/2005
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Last Update Date | 09/25/2019
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Provider Practice Location Address
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Address Line | 17450 ST LUKES WAY STE 290
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City | THE WOODLANDS
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State | TX
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Zip | 77384-8045
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Country | US
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Telephone | 936-283-0264
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Fax | 936-828-2498
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Provider Business Mailing Address
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Address Line | PO BOX 4248 DEPARTMENT 315
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City | HOUSTON
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State | TX
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Zip | 77210-4248
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Country | US
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Telephone | 936-283-0264
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Fax | 936-828-2498
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | K6486
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | K6486
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License Number State | TX
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