Provider Demographics
NPI:1023225794
Name:MARK A. WREN, M.D., P.A.
Entity type:Organization
Organization Name:MARK A. WREN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:WREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-330-0496
Mailing Address - Street 1:4613 PARKWAY DR STE 1
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-1142
Mailing Address - Country:US
Mailing Address - Phone:870-330-0496
Mailing Address - Fax:870-330-0499
Practice Address - Street 1:4613 PARKWAY DR STE 1
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1142
Practice Address - Country:US
Practice Address - Phone:870-330-0496
Practice Address - Fax:870-330-0499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0099KWOtherBLUE CROSS BLUE SHIELD OF TEXAS
TX00749WMedicare ID - Type Unspecified
TXF43899Medicare UPIN