Provider Demographics
NPI:1609070291
Name:SCIBIELSKI, PAUL MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MARK
Last Name:SCIBIELSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11770 JOLLYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759
Mailing Address - Country:US
Mailing Address - Phone:512-732-2774
Mailing Address - Fax:512-331-5192
Practice Address - Street 1:5402 S. STAPLES ST.
Practice Address - Street 2:#205
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411
Practice Address - Country:US
Practice Address - Phone:361-882-3487
Practice Address - Fax:361-882-3811
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8323207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00712NOtherMEDICARE GROUP PTAN
TX8K8210OtherINDIVIDUAL MEDICARE PTAN
TX081040002Medicaid