MEDICARE: MARK LELAND LOBAUGH MD

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	207V00000X	Obstetrics & Gynecology Physician	G061664	CA
2	207V00000X	Obstetrics & Gynecology Physician	L3544	TX

General Provider Information

NPI Number	:	1710984091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK LELAND LOBAUGH MD

Provider Business Mailing Address
First Line	:	1208 MOUNTAIN RIDGE CT
Second Line	:
City	:	NOLANVILLE
State	:	TX
Zip	:	76559-4649
Country	:	US
Telephone Number	:	254-432-9685
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 W CENTRAL TEXAS EXPY
Second Line	:	SUITE 200
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-1899
Country	:	US
Telephone Number	:	254-519-2229
Fax Number	:	254-519-2231

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

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	01/12/2021

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Directions to “ MARK LELAND LOBAUGH MD” Practice Location

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