Provider Demographics
NPI:1417956533
Name:CANALES, MARK L (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:CANALES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7434 LOUIS PASTEUR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4538
Mailing Address - Country:US
Mailing Address - Phone:210-949-0304
Mailing Address - Fax:210-949-0310
Practice Address - Street 1:5430 FREDERICKSBURG RD STE 400
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3539
Practice Address - Country:US
Practice Address - Phone:210-538-2301
Practice Address - Fax:210-949-0310
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2018-03-17
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Provider Licenses
StateLicense IDTaxonomies
TXH2285207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129159307Medicaid
TX8C6105Medicare ID - Type Unspecified