Provider Demographics
NPI:1255327383
Name:MCCURDY, MARK ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:MCCURDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:811 W INTERSTATE 20 STE 114
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-5871
Mailing Address - Country:US
Mailing Address - Phone:817-784-8268
Mailing Address - Fax:817-804-8178
Practice Address - Street 1:811 W INTERSTATE 20 STE 114
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017
Practice Address - Country:US
Practice Address - Phone:817-784-8268
Practice Address - Fax:817-804-8178
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0345208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136576907Medicaid
TX136576908Medicaid
TX136576910Medicaid
TX136576912Medicaid
TX136576909Medicaid
TX136576912Medicaid
TX8036J4Medicare PIN
TX136576910Medicaid
TX136576908Medicaid
TXG49601Medicare UPIN