Provider Demographics
NPI:1043389141
Name:DREW, MARK CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:CHRISTOPHER
Last Name:DREW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 840026
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0026
Mailing Address - Country:US
Mailing Address - Phone:806-212-6965
Mailing Address - Fax:806-212-6278
Practice Address - Street 1:1000 S COULTER ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1781
Practice Address - Country:US
Practice Address - Phone:806-212-4700
Practice Address - Fax:806-212-4730
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5312208D00000X, 207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124880907Medicaid
TX124880907Medicaid
TXF69229Medicare UPIN
TX001012313Medicaid