Provider Demographics
NPI:1790789303
Name:LAYMAN, MARK B (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:B
Last Name:LAYMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 836
Mailing Address - Street 2:
Mailing Address - City:LOOP
Mailing Address - State:TX
Mailing Address - Zip Code:79342-0836
Mailing Address - Country:US
Mailing Address - Phone:806-487-6480
Mailing Address - Fax:806-487-6847
Practice Address - Street 1:208 NW 8TH ST
Practice Address - Street 2:STE 1
Practice Address - City:SEMINOLE
Practice Address - State:TX
Practice Address - Zip Code:79360-3448
Practice Address - Country:US
Practice Address - Phone:432-758-6363
Practice Address - Fax:432-758-6550
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK9104207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096903202Medicaid
TX0047DYOtherBCBS OF TEXAS
TX121479OtherCHIPS NUMBER
TX117485100OtherFIRSTCARE ID
TX0047DYOtherBCBS OF TEXAS
TXHO5133Medicare UPIN