Provider Demographics
NPI:1942399316
Name:RILEY, MARK B (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:B
Last Name:RILEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2803 EARL RUDDER FWY S STE 103
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-6099
Mailing Address - Country:US
Mailing Address - Phone:979-731-8888
Mailing Address - Fax:979-731-8848
Practice Address - Street 1:2803 EARL RUDDER FWY S STE 103
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-6099
Practice Address - Country:US
Practice Address - Phone:979-731-8888
Practice Address - Fax:979-731-8848
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF3306207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8U5904OtherBLUE CROSS BLUE SHIELD
TX110280806Medicaid
TXP00410987OtherRAILROAD MEDICARE
TXP00410987OtherRAILROAD MEDICARE
TX8J5080Medicare PIN