Provider Demographics
NPI:1467404426
Name:ERNST, MARK (PA)
Entity Type:Individual
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First Name:MARK
Middle Name:
Last Name:ERNST
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Gender:M
Credentials:PA
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Mailing Address - Street 1:7430 REMCON CIR
Mailing Address - Street 2:SUITE B110
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3514
Mailing Address - Country:US
Mailing Address - Phone:915-544-2455
Mailing Address - Fax:915-544-3149
Practice Address - Street 1:1300 MURCHISON DR
Practice Address - Street 2:SUITE 310
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4842
Practice Address - Country:US
Practice Address - Phone:915-838-3888
Practice Address - Fax:915-838-3889
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-08-16
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Provider Licenses
StateLicense IDTaxonomies
TXPA02905363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G5660Medicare UPIN