MEDICARE: DR. MARK RICHARD DAMBRO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	H3998	TX
2	208D00000X	General Practice Physician	H3998	TX

General Provider Information

NPI Number	:	1528061009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK RICHARD DAMBRO M.D.

Provider Business Mailing Address
First Line	:	13621 NOUVELLE CIR
Second Line	:
City	:	ALEDO
State	:	TX
Zip	:	76008-1922
Country	:	US
Telephone Number	:	817-233-8781
Fax Number	:

Provider Business Practice Location Address
First Line	:	13621 NOUVELLE CIR
Second Line	:
City	:	ALEDO
State	:	TX
Zip	:	76008-1922
Country	:	US
Telephone Number	:	817-233-8781
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	02/26/2026

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