Provider Demographics
NPI:1114573144
Name:MISHAK, MARK G II (PA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:G
Last Name:MISHAK
Suffix:II
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 1358
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-0014
Mailing Address - Country:US
Mailing Address - Phone:254-965-2663
Mailing Address - Fax:254-968-5912
Practice Address - Street 1:561 N GRAHAM ST
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-3548
Practice Address - Country:US
Practice Address - Phone:254-965-2663
Practice Address - Fax:254-968-5912
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2020-06-01
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant