Provider Demographics
NPI:1245376219
Name:DOSMANN, MARK ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLEN
Last Name:DOSMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17423 RANCHO DIANA
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-3365
Mailing Address - Country:US
Mailing Address - Phone:210-239-5551
Mailing Address - Fax:
Practice Address - Street 1:17423 RANCHO DIANA
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78255-3365
Practice Address - Country:US
Practice Address - Phone:210-239-5551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2023-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ50882085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP00177045OtherRAILROAD MEDICARE
GA307567283AMedicaid
AL051554701Medicaid
AL051524274OtherBLUE CROSS BLUE SHIELD
AL051524274OtherBLUE CROSS BLUE SHIELD
AL051554701Medicare PIN