Provider Demographics
NPI:1720425242
Name:FIERRO, MARK DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DANIEL
Last Name:FIERRO
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 1:800 W CENTRAL TEXAS EXPY
Mailing Address - Street 2:SUITE 125
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-1899
Mailing Address - Country:US
Mailing Address - Phone:254-618-1050
Mailing Address - Fax:
Practice Address - Street 1:800 W CENTRAL TEXAS EXPY
Practice Address - Street 2:SUITE 125
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-1899
Practice Address - Country:US
Practice Address - Phone:254-618-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9408101207Q00000X
IAMD-43099207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine