Provider Demographics
NPI:1558339242
Name:HEARD, MARK ALAN (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:HEARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2500 N ESPLANADE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CUERO
Mailing Address - State:TX
Mailing Address - Zip Code:77954-4727
Mailing Address - Country:US
Mailing Address - Phone:361-275-3466
Mailing Address - Fax:361-275-3469
Practice Address - Street 1:2500 N ESPLANADE
Practice Address - Street 2:SUITE 102
Practice Address - City:CUERO
Practice Address - State:TX
Practice Address - Zip Code:77954-4727
Practice Address - Country:US
Practice Address - Phone:361-275-3466
Practice Address - Fax:361-275-3460
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG3446207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137263312Medicaid
B23379Medicare UPIN
TX137263312Medicaid