Provider Demographics
NPI:1689963829
Name:MARK E MCDONNELL DPM PA
Entity Type:Organization
Organization Name:MARK E MCDONNELL DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCDONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:512-301-5350
Mailing Address - Street 1:1340 WONDER WORLD DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7598
Mailing Address - Country:US
Mailing Address - Phone:512-878-4203
Mailing Address - Fax:512-878-4209
Practice Address - Street 1:7900 FM 1826
Practice Address - Street 2:BLDG 2, STE. 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737-1407
Practice Address - Country:US
Practice Address - Phone:512-301-5350
Practice Address - Fax:512-301-5395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-28
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty