Provider Demographics
NPI:1275531840
Name:MARK D STOECKEL, M.D., P.A.
Entity Type:Organization
Organization Name:MARK D STOECKEL, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:STOECKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-528-0200
Mailing Address - Street 1:701 E WHITESTONE BLVD
Mailing Address - Street 2:BLDG 2, SUITE 125
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-6944
Mailing Address - Country:US
Mailing Address - Phone:512-528-0200
Mailing Address - Fax:512-528-0249
Practice Address - Street 1:701 E WHITESTONE BLVD
Practice Address - Street 2:BLDG 2, SUITE 125
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-6944
Practice Address - Country:US
Practice Address - Phone:512-528-0200
Practice Address - Fax:512-528-0249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3845207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00318WMedicare PIN