Provider Demographics
NPI:1619560844
Name:MARK RAY MD DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:MARK RAY MD DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:KIRKLIN
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-988-9945
Mailing Address - Street 1:1008 LONG ISLES LN
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-5684
Mailing Address - Country:US
Mailing Address - Phone:972-896-8824
Mailing Address - Fax:469-393-9945
Practice Address - Street 1:2601 LITTLE ELM PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-6677
Practice Address - Country:US
Practice Address - Phone:972-988-9945
Practice Address - Fax:469-393-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-18
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty