Provider Demographics
NPI:1861667099
Name:MARK E SOWELL DPM INC
Entity Type:Organization
Organization Name:MARK E SOWELL DPM INC
Other - Org Name:SOWELL PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:SOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:936-559-1700
Mailing Address - Street 1:3316 N UNIVERSITY DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-2632
Mailing Address - Country:US
Mailing Address - Phone:936-559-1700
Mailing Address - Fax:936-559-1713
Practice Address - Street 1:3316 N UNIVERSITY DR
Practice Address - Street 2:SUITE C
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-2632
Practice Address - Country:US
Practice Address - Phone:936-559-1700
Practice Address - Fax:936-559-1713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1449332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX480029919OtherRAILROAD MEDICARE PTAN
TX0096DSOtherBLUE CROSS/BLUE SHIELD
TX018599301Medicaid
TXU67314Medicare UPIN
TX018599301Medicaid
TX0096DSOtherBLUE CROSS/BLUE SHIELD