Provider Demographics
NPI:1497944664
Name:MARK J FLORIAN MD PA
Entity Type:Organization
Organization Name:MARK J FLORIAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:FLORIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-731-8465
Mailing Address - Street 1:3201 UNIVERSITY DR E
Mailing Address - Street 2:SUITE 345
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-3475
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3201 UNIVERSITY DR E
Practice Address - Street 2:SUITE 345
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3475
Practice Address - Country:US
Practice Address - Phone:979-731-8465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2017207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1396768347OtherTYPE 1 INDIVIDUAL NPI
TX0047QPOtherBLUE CROSS BLUE SHIELD