Provider Demographics
NPI:1285848127
Name:FERRANTE, MARK ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANTHONY
Last Name:FERRANTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:562 S. HWY 123 BYPASS
Mailing Address - Street 2:PMB 196
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-9752
Mailing Address - Country:US
Mailing Address - Phone:830-401-7558
Mailing Address - Fax:830-401-7640
Practice Address - Street 1:1339 E COURT
Practice Address - Street 2:#230
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5141
Practice Address - Country:US
Practice Address - Phone:830-379-4422
Practice Address - Fax:830-379-4424
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.0127292084N0400X
TXN07612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX280964201Medicaid