Bayouth, John Mark

Bayouth, John Mark is an individual health care provider with primary practice located at 900 W Magnolia Ave Ste 200 , Fort Worth TX 76104-8517. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Bayouth, John Mark can be contacted via phone (817) 882-1193.

Contact Information

Primary practice address
900 W Magnolia Ave Ste 200 Fort Worth TX 76104-8517
Phone: (817) 882-1193
Fax: (817) 870-1602
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X K3553 Texas

Profile Details

NPI number 1710904396
LBN Legal business name Bayouth, John Mark
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 17th, 2006
Last updated Nov 4th, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710904396 NPPES
Texas Other 030746407 MEDICAID CSHCN
Texas MEDICAID 030746404 MEDICAID CSHCN
Texas Other P00265372 MEDICAID CSHCN
Texas MEDICAID 030746405 MEDICAID CSHCN
Texas Other 030746408 MEDICAID CSHCN

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