Provider Demographics
NPI:1053477950
Name:AZEL, MARK ALEXANDER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALEXANDER
Last Name:AZEL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:16314 MORAN PL APT A
Mailing Address - Street 2:
Mailing Address - City:FORT POLK
Mailing Address - State:LA
Mailing Address - Zip Code:71459-2576
Mailing Address - Country:US
Mailing Address - Phone:337-537-8979
Mailing Address - Fax:
Practice Address - Street 1:46TH ENGINEER COMBAT BATTALION
Practice Address - Street 2:BLDG. 2264, SUITE 105
Practice Address - City:FORT POLK
Practice Address - State:LA
Practice Address - Zip Code:71459
Practice Address - Country:US
Practice Address - Phone:337-531-4233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
1052506363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant