Provider Demographics
NPI:1780867002
Name:FLESHER, MARK ALLEN (PA-C)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:FLESHER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6311 SOUTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76132-1063
Mailing Address - Country:US
Mailing Address - Phone:817-731-9400
Mailing Address - Fax:817-731-4282
Practice Address - Street 1:6311 SOUTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76132-1063
Practice Address - Country:US
Practice Address - Phone:817-731-9400
Practice Address - Fax:817-731-4282
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K6810Medicare PIN