Provider Demographics
NPI:1801859723
Name:D'ALISE, MARK D (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:D'ALISE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5219 CITY BANK PKWY STE 35
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3545
Mailing Address - Country:US
Mailing Address - Phone:806-761-0333
Mailing Address - Fax:806-782-0097
Practice Address - Street 1:3502 9TH ST STE 440
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-3368
Practice Address - Country:US
Practice Address - Phone:806-761-0535
Practice Address - Fax:806-761-0534
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2021-03-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ8979207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8FM001OtherBCBS
TX125356907Medicaid
TX335026YKT8OtherMEDICARE
TX84822FMedicare PIN
TXG40506Medicare UPIN