Provider Demographics
NPI:1033395074
Name:TUSA, MARK GROGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:GROGAN
Last Name:TUSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 W ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76501-4211
Mailing Address - Country:US
Mailing Address - Phone:254-742-3775
Mailing Address - Fax:
Practice Address - Street 1:409 W ADAMS AVE
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76501-4211
Practice Address - Country:US
Practice Address - Phone:254-742-3775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-20
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8395207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology