Tellez, Mark L

Tellez, Mark L is an individual health care provider with primary practice located at 1500 S Main St Suite 303, Fort Worth TX 76104-4917. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Tellez, Mark L can be contacted via phone (817) 702-1172.

Contact Information

Primary practice address
1500 S Main St Suite 303 Fort Worth TX 76104-4917
Phone: (817) 702-1172
Fax: (817) 702-1605
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X L1214 Texas

Profile Details

NPI number 1164445102
LBN Legal business name Tellez, Mark L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 25th, 2006
Last updated Feb 14th, 2017 - about 8 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 1164445102 NPPES
Other P00308741 RAILROAD
MEDICAID 140972402 RAILROAD
MEDICAID 140972403 RAILROAD

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