Provider Demographics
NPI:1902857006
Name:LANDEROS, MARK M (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:M
Last Name:LANDEROS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1700 CURIE DR
Mailing Address - Street 2:STE 1500
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2905
Mailing Address - Country:US
Mailing Address - Phone:915-543-9600
Mailing Address - Fax:915-543-9700
Practice Address - Street 1:1700 CURIE DR
Practice Address - Street 2:STE 1500
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2905
Practice Address - Country:US
Practice Address - Phone:915-543-9600
Practice Address - Fax:915-543-9700
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK7571208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX008791K0OtherBCBS
TX096604601Medicaid
TX096604601Medicaid
TX8791K0Medicare PIN