Provider Demographics
NPI:1982911244
Name:MARK A. CLOTHIER, M.D., P.A.
Entity Type:Organization
Organization Name:MARK A. CLOTHIER, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLOTHIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-342-3651
Mailing Address - Street 1:600 E COKE RD
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75494-3418
Mailing Address - Country:US
Mailing Address - Phone:903-342-3651
Mailing Address - Fax:903-342-6747
Practice Address - Street 1:600 E COKE RD
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:TX
Practice Address - Zip Code:75494-3418
Practice Address - Country:US
Practice Address - Phone:903-342-3651
Practice Address - Fax:903-342-6747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4920207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX005445801Medicaid
TX060004887OtherRAILROAD MEDICARE
TXB21908Medicare UPIN
TXTXB114968Medicare PIN