Provider Demographics
NPI:1609848241
Name:PAPE, MARK W (PT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:W
Last Name:PAPE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:1422 MACKENZIE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-4632
Mailing Address - Country:US
Mailing Address - Phone:325-653-0521
Mailing Address - Fax:325-942-2548
Practice Address - Street 1:312 WESTOVER RD
Practice Address - Street 2:SUITE 7
Practice Address - City:LACKLAND A F B
Practice Address - State:TX
Practice Address - Zip Code:78236-0121
Practice Address - Country:US
Practice Address - Phone:210-925-7188
Practice Address - Fax:210-925-0199
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1027472171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider