Provider Demographics
NPI:1811912041
Name:BLICK, MARK B (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:B
Last Name:BLICK
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Gender:M
Credentials:DO
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Mailing Address - Street 1:6565 WEST LOOP S
Mailing Address - Street 2:SUITE# 300
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3500
Mailing Address - Country:US
Mailing Address - Phone:713-850-7272
Mailing Address - Fax:713-877-0970
Practice Address - Street 1:6565 WEST LOOP S
Practice Address - Street 2:SUITE# 300
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3500
Practice Address - Country:US
Practice Address - Phone:713-850-7272
Practice Address - Fax:713-877-0970
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2011-03-16
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Provider Licenses
StateLicense IDTaxonomies
TXG3933207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0014HWOtherBLUE CROSS BLUE SHIELD
TXDA1623OtherMEDICARE RAILROAD GROUP
TX900004448OtherMEDICARE RAILROAD RENDERI
TX900004448OtherMEDICARE RAILROAD RENDERI