Provider Demographics
NPI:1427043967
Name:METTAUER, MARK MENEFEE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:MENEFEE
Last Name:METTAUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4248 DEPARTMENT 315
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4248
Mailing Address - Country:US
Mailing Address - Phone:936-283-0264
Mailing Address - Fax:936-828-2498
Practice Address - Street 1:17450 ST LUKES WAY STE 290
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-8045
Practice Address - Country:US
Practice Address - Phone:936-283-0264
Practice Address - Fax:936-828-2498
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6486208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1560930-03Medicaid
TX1560930-03Medicaid
TX8C0600Medicare PIN