MEDICARE: DR. MARK H HEBERT 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	207L00000X	Anesthesiology Physician	E8544	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	G58S	OTHER	TX	BLUE CROSS BLUE SHIELD ID

General Provider Information

NPI Number	:	1952303067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK H HEBERT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 650759
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75265-0759
Country	:	US
Telephone Number	:	214-696-3540
Fax Number	:	214-696-1230

Provider Business Practice Location Address
First Line	:	10830 N CENTRAL EXPY
Second Line	:	STE 330
City	:	DALLAS
State	:	TX
Zip	:	75231-1050
Country	:	US
Telephone Number	:	214-696-3540
Fax Number	:	214-696-1230

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	11/16/2008

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Directions to “ DR. MARK H HEBERT M.D.” Practice Location

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