Provider Demographics
NPI:1356552509
Name:LEDOUX, MARK A (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:LEDOUX
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 1:17051 DALLAS PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-7105
Mailing Address - Country:US
Mailing Address - Phone:214-888-3900
Mailing Address - Fax:214-888-3901
Practice Address - Street 1:17051 DALLAS PKWY STE 300
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-7105
Practice Address - Country:US
Practice Address - Phone:214-888-3900
Practice Address - Fax:214-888-3901
Is Sole Proprietor?:No
Enumeration Date:2007-05-26
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM8781207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM8781OtherTMB
TX8L17155Medicare PIN