Provider Demographics
NPI:1881911360
Name:MARY ANN PISKUN, MD, PLLC
Entity type:Organization
Organization Name:MARY ANN PISKUN, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PISKUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-358-8731
Mailing Address - Street 1:1801 HALSTEAD ST STE B
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1811
Mailing Address - Country:US
Mailing Address - Phone:806-358-8731
Mailing Address - Fax:806-358-8837
Practice Address - Street 1:1801 HALSTEAD ST STE B
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1811
Practice Address - Country:US
Practice Address - Phone:806-358-8731
Practice Address - Fax:806-358-8837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0156208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty