Provider Demographics
NPI:1356480669
Name:MAUNDER, MARK EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EDWARD
Last Name:MAUNDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:511 OAKWOOD BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4068
Mailing Address - Country:US
Mailing Address - Phone:512-244-3698
Mailing Address - Fax:512-244-0214
Practice Address - Street 1:511 OAKWOOD BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4068
Practice Address - Country:US
Practice Address - Phone:512-244-3698
Practice Address - Fax:512-244-0214
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8242207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138553613Medicaid
TX138553613Medicaid