Provider Demographics
NPI:1699711721
Name:MARK G GOSS MD PA
Entity type:Organization
Organization Name:MARK G GOSS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:G
Authorized Official - Last Name:GOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-627-0013
Mailing Address - Street 1:2301 S FM 51
Mailing Address - Street 2:STE 500
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3865
Mailing Address - Country:US
Mailing Address - Phone:940-627-0013
Mailing Address - Fax:940-627-1900
Practice Address - Street 1:2301 S FM 51
Practice Address - Street 2:STE 500
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3865
Practice Address - Country:US
Practice Address - Phone:940-627-0013
Practice Address - Fax:940-627-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177718701Medicaid
TX0037NAOtherBCBSTX
TXDF5668OtherMEDICARE RAILROAD