Provider Demographics
NPI:1831107028
Name:MARK L ELDORE MD PLLC
Entity Type:Organization
Organization Name:MARK L ELDORE MD PLLC
Other - Org Name:ATHENS WOMEN'S AND CHILDREN'S CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:ELDORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-675-7376
Mailing Address - Street 1:824 SOUTHPARK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75752
Mailing Address - Country:US
Mailing Address - Phone:903-675-7376
Mailing Address - Fax:903-677-4234
Practice Address - Street 1:824 SOUTHPARK CIRCLE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75752
Practice Address - Country:US
Practice Address - Phone:903-675-7376
Practice Address - Fax:903-677-4234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178423301Medicaid
TX00W004Medicare PIN
TX0053MQOtherBCBS