Provider Demographics
NPI:1497105084
Name:UTMB
Entity Type:Organization
Organization Name:UTMB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:409-722-5255
Mailing Address - Street 1:3060 FM 3514
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77705-7635
Mailing Address - Country:US
Mailing Address - Phone:409-722-5255
Mailing Address - Fax:409-719-4157
Practice Address - Street 1:3060 FM 3514
Practice Address - Street 2:MEDICAL DEPARTMENT - MS. ADODO
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77705-7635
Practice Address - Country:US
Practice Address - Phone:409-722-5255
Practice Address - Fax:409-719-4157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131092363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty