Provider Demographics
NPI:1477526374
Name:MCDONNELL, MARK E (DPM)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:MCDONNELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1305 WONDER WORLD DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7546
Mailing Address - Country:US
Mailing Address - Phone:512-353-8661
Mailing Address - Fax:512-353-8355
Practice Address - Street 1:1305 WONDER WORLD DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7546
Practice Address - Country:US
Practice Address - Phone:512-353-8661
Practice Address - Fax:512-353-8355
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1440207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU81483Medicare UPIN
TX8472K1Medicare ID - Type Unspecified