Provider Demographics
NPI:1952416158
Name:MANKINS, MARK L (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:MANKINS
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:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76374-0157
Mailing Address - Country:US
Mailing Address - Phone:940-564-3546
Mailing Address - Fax:940-564-8882
Practice Address - Street 1:306 W MAIN ST
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:TX
Practice Address - Zip Code:76374-1851
Practice Address - Country:US
Practice Address - Phone:940-564-3546
Practice Address - Fax:940-564-8882
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0599207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A5557Medicare ID - Type Unspecified
TXB24607Medicare UPIN