Provider Demographics
NPI:1639259039
Name:MAFFET, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MAFFET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16811 SOUTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4728
Mailing Address - Country:US
Mailing Address - Phone:281-690-4678
Mailing Address - Fax:
Practice Address - Street 1:16811 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:281-690-4678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7633207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128829209Medicaid
TX128829210Medicaid
TX610119705 BROOKSOtherUS DEPT OF LABOR
TX128829211Medicaid
TX1639259039OtherBLUE CROSS BLUE SHIELD
TXPENDINGMedicaid
TXP00894860OtherRR MEDICARE
TXP00916187OtherMEDICARE RR
TXP01089605OtherRR MEDICARE
TX128829212Medicaid
TX128829213Medicaid
TX128829208Medicaid
TX610119701OtherUS DEPT OF LABOR
TX610119705 BROOKSOtherUS DEPT OF LABOR
TX128829213Medicaid
TX128829210Medicaid
TX128829211Medicaid
TXTXB151358Medicare PIN
TXTXB151357Medicare PIN