Provider Demographics
NPI:1720126055
Name:NEUMANN, MARK J (PA-C)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:NEUMANN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-2210
Mailing Address - Country:US
Mailing Address - Phone:512-947-1897
Mailing Address - Fax:512-487-5376
Practice Address - Street 1:1301 WONDER WORLD DR
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7533
Practice Address - Country:US
Practice Address - Phone:512-753-3516
Practice Address - Fax:512-753-3538
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05346363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L7030Medicare PIN
TX8L7029Medicare PIN