Coburn, Mark W
Coburn, Mark W is an individual health care provider with primary practice located at 300 University Blvd , Round Rock TX 78665-1032. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Coburn, Mark W can be contacted via phone (512) 509-0100.Contact Information
Primary practice address
300 University Blvd
Round Rock TX 78665-1032
Phone: (512) 509-0100
Fax: (512) 218-6330
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 108365 | Missouri |
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | N4357 | Texas |
Profile Details
| NPI number | 1811035694 |
|---|---|
| LBN Legal business name | Coburn, Mark W |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 2nd, 2007 |
| Last updated | Jan 13th, 2021 - about 3 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1811035694 | NPPES |
| Missouri | Other | 173098 | MO BLUE SHIELD |
| Missouri | MEDICAID | 140791001 | MO BLUE SHIELD |
| Missouri | MEDICAID | 205007503 | MO BLUE SHIELD |
| Missouri | Other | 98569 | MO BLUE SHIELD |
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