Provider Demographics
NPI:1104802875
Name:GYENES, MARK RICHARD (HS(IDC/DMT))
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:RICHARD
Last Name:GYENES
Suffix:
Gender:M
Credentials:HS(IDC/DMT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 AUCTION AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-1502
Mailing Address - Country:US
Mailing Address - Phone:901-544-3912
Mailing Address - Fax:901-544-3915
Practice Address - Street 1:2 AUCTION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-1502
Practice Address - Country:US
Practice Address - Phone:901-544-3912
Practice Address - Fax:901-544-3915
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNB1583538146N00000X
1710I1002X, 1710I1003X, 247000000X, 247200000X
MDA00065327376K00000X
TN3900062376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Not Answered1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Not Answered1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians
Not Answered247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information
Not Answered247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Not Answered376K00000XNursing Service Related ProvidersNurse's Aide