Provider Demographics
NPI:1588750772
Name:TURRENTINE, MARK A (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:TURRENTINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 AUGUSTA DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-2209
Mailing Address - Country:US
Mailing Address - Phone:713-442-2400
Mailing Address - Fax:
Practice Address - Street 1:1111 AUGUSTA DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-2209
Practice Address - Country:US
Practice Address - Phone:713-442-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3642207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134373309Medicaid
TX134373308Medicaid
TX134373306Medicaid
TX134373310Medicaid
TX8B3841Medicare PIN
TX80951NMedicare PIN
TX8B3842Medicare PIN
TX8B3843Medicare PIN