Provider Demographics
NPI:1801866215
Name:DENNIS, MARK STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEPHEN
Last Name:DENNIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:235 SAINT ANN DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3396
Mailing Address - Country:US
Mailing Address - Phone:985-727-7275
Mailing Address - Fax:985-727-7915
Practice Address - Street 1:235 SAINT ANN DR
Practice Address - Street 2:SUITE 2
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3396
Practice Address - Country:US
Practice Address - Phone:985-727-7275
Practice Address - Fax:985-727-7915
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA019030174400000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00249171OtherRR MEDICARE
LAP00249171OtherRR MEDICARE
LAE39941Medicare UPIN