Provider Demographics
NPI:1952303067
Name:HEBERT, MARK H (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:H
Last Name:HEBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 650759
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0759
Mailing Address - Country:US
Mailing Address - Phone:214-696-3540
Mailing Address - Fax:214-696-1230
Practice Address - Street 1:10830 N CENTRAL EXPY
Practice Address - Street 2:STE 330
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-1050
Practice Address - Country:US
Practice Address - Phone:214-696-3540
Practice Address - Fax:214-696-1230
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2008-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8544207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098516002Medicaid
TXG58SOtherBLUE CROSS BLUE SHIELD ID
TX098516002Medicaid
TX00G58SMedicare PIN