MEDICARE: DR. MARK EDWARD SKELLENGER 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	174400000X	Specialist	E6620	TX

General Provider Information

NPI Number	:	1588779011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK EDWARD SKELLENGER M.D.

Provider Business Mailing Address
First Line	:	445 BAY AREA BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-2622
Country	:	US
Telephone Number	:	281-990-8346
Fax Number	:	281-990-9984

Provider Business Practice Location Address
First Line	:	445 BAY AREA BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-2622
Country	:	US
Telephone Number	:	281-990-8346
Fax Number	:	281-990-9984

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/29/2008

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