Provider Demographics
NPI:1003819913
Name:RENFRO, MARK B (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:B
Last Name:RENFRO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:700 OLYMPIC PLAZA CIR
Mailing Address - Street 2:STE 850
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1955
Mailing Address - Country:US
Mailing Address - Phone:903-595-2441
Mailing Address - Fax:903-595-0743
Practice Address - Street 1:700 OLYMPIC PLAZA CIR
Practice Address - Street 2:STE 850
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1955
Practice Address - Country:US
Practice Address - Phone:903-595-2441
Practice Address - Fax:903-595-0743
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
TXK3425207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG45605Medicare UPIN
TX87A602Medicare ID - Type Unspecified