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General NPI Number Information
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NPI Number | 1437274537
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Entity Type | Individual
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Provider Name | COREY J. MARK M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 09/13/2020
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Provider Practice Location Address
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Address Line | 1310 PALUXY RD STE 3000
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City | GRANBURY
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State | TX
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Zip | 76048-5655
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Country | US
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Telephone | 817-579-3906
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Fax | 817-579-3905
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Provider Business Mailing Address
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Address Line | 1310 PALUXY RD STE 3000
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City | GRANBURY
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State | TX
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Zip | 76048-5655
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Country | US
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Telephone | 817-579-3906
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Fax | 817-579-3905
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 752743893
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License Number State | TX
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