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General NPI Number Information
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NPI Number | 1710904396
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Entity Type | Individual
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Provider Name | JOHN MARK BAYOUTH MD
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 08/04/2024
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Provider Practice Location Address
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Address Line | 2600 ALEMEDA ST STE 202
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City | FORT WORTH
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State | TX
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Zip | 76108-4042
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Country | US
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Telephone | 817-922-9229
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Fax | 949-703-7250
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Provider Business Mailing Address
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Address Line | 4662 SANTA COVA CT
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City | FORT WORTH
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State | TX
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Zip | 76126-1939
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Country | US
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Telephone | 817-371-0920
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Fax | 949-703-7250
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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 | K3553
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License Number State | TX
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