Provider Demographics
NPI:1851342638
Name:GOSS, MARK G (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:G
Last Name:GOSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4211 JOE RAMSEY BLVD E STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-7856
Mailing Address - Country:US
Mailing Address - Phone:903-408-5770
Mailing Address - Fax:903-408-5779
Practice Address - Street 1:4211 JOE RAMSEY BLVD E STE 100
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7856
Practice Address - Country:US
Practice Address - Phone:903-408-5770
Practice Address - Fax:903-408-5779
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ4162208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00375814OtherMEDICARE RAILROAD
TX122308304Medicaid
G17096Medicare UPIN
TXP00375814OtherMEDICARE RAILROAD