Provider Demographics
NPI:1093706012
Name:CAFFEY, MARK STEPHEN (PT, OCS)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:STEPHEN
Last Name:CAFFEY
Suffix:
Gender:M
Credentials:PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6913 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-6111
Mailing Address - Country:US
Mailing Address - Phone:806-687-2788
Mailing Address - Fax:806-687-2791
Practice Address - Street 1:6913 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-6111
Practice Address - Country:US
Practice Address - Phone:806-687-2788
Practice Address - Fax:806-687-2791
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1085884174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T2722OtherBLUE CROSS BLUE SHIELD
TX8C2537Medicare ID - Type UnspecifiedMEDICARE