Provider Demographics
NPI:1710981220
Name:COUTURE, MARK (DPM)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:COUTURE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7125 NEW SANGER ROAD
Mailing Address - Street 2:SUITE 502
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-4054
Mailing Address - Country:US
Mailing Address - Phone:254-732-2224
Mailing Address - Fax:254-732-2226
Practice Address - Street 1:7125 NEW SANGER ROAD
Practice Address - Street 2:SUITE 502
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-4054
Practice Address - Country:US
Practice Address - Phone:254-776-6995
Practice Address - Fax:254-776-5577
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1651213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8M5110OtherBCBS
TX169630401OtherMEDICAID OVER 21
TX159939102Medicaid
TX169630403OtherMEDICAID UNDER 21
TXP00143574OtherMEDICARE RAILROAD
TX159939102Medicaid
TX8M5110OtherBCBS
TX8B6211Medicare PIN