Provider Demographics
NPI:1912990987
Name:CO, MARK ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLEN
Last Name:CO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9330 POPPY DR
Mailing Address - Street 2:#503
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-4621
Mailing Address - Country:US
Mailing Address - Phone:214-321-1231
Mailing Address - Fax:214-321-1496
Practice Address - Street 1:9330 POPPY DR
Practice Address - Street 2:#503
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-4621
Practice Address - Country:US
Practice Address - Phone:214-321-1231
Practice Address - Fax:214-321-1496
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2011-04-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXH5857207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096893502Medicaid
E03453Medicare UPIN
TX096893502Medicaid