Provider Demographics
NPI:1891987434
Name:RUFUS J. MARK, M.D., P.A.
Entity Type:Organization
Organization Name:RUFUS J. MARK, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUFUS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-796-1122
Mailing Address - Street 1:4302 22ND PL
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1140
Mailing Address - Country:US
Mailing Address - Phone:806-796-1122
Mailing Address - Fax:806-796-1401
Practice Address - Street 1:4101 22ND PL
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1121
Practice Address - Country:US
Practice Address - Phone:806-796-1122
Practice Address - Fax:806-796-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL24452085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNDP0481OtherRAILROAD MEDICARE
NMNM007M14OtherBCBS-NM GROUP
NM18601260Medicaid
NMDN1664OtherRAILROAD MEDICARE
TX1958159Medicaid
TX00038RVOtherBCBS TX
TX1958159OtherMEDICAID TX
TNDP0481OtherRAILROAD MEDICARE
TX00491QMedicare PIN