Provider Demographics
NPI:1336288315
Name:MARK PRETORIUS, M.D. P.A.
Entity Type:Organization
Organization Name:MARK PRETORIUS, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:PRETORIUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-596-5144
Mailing Address - Street 1:5201 CORINTHIAN BAY DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4028
Mailing Address - Country:US
Mailing Address - Phone:972-596-5144
Mailing Address - Fax:972-596-2128
Practice Address - Street 1:5201 CORINTHIAN BAY DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4028
Practice Address - Country:US
Practice Address - Phone:972-596-5144
Practice Address - Fax:972-596-2128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF43922084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDD4519OtherRAILROAD MEDICARE
TX166099501Medicaid
TX0050RPOtherBCBS
TX166099501Medicaid
00184VMedicare PIN