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General NPI Number Information
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NPI Number | 1619560844
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Entity Type | Organization
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Legal Business Name | MARK RAY MD DERMATOLOGY PLLC
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Dates
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Enumeration Date | 02/18/2021
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Last Update Date | 04/13/2021
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Provider Practice Location Address
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Address Line | 2601 LITTLE ELM PKWY SUITE 101
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City | LITTLE ELM
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State | TX
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Zip | 75068-6677
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Country | US
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Telephone | 972-988-9945
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Fax | 469-393-7707
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Provider Business Mailing Address
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Address Line | 1008 LONG ISLES LN
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City | LEWISVILLE
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State | TX
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Zip | 75056-5684
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Country | US
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Telephone | 972-896-8824
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Fax | 469-393-9945
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK KIRKLIN RAY
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Credential | MD
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Telephone | 972-988-9945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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