Provider Demographics
NPI:1962864488
Name:CORREA, MARK (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:CORREA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:4419 FRONTIER TRL STE 110
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1567
Mailing Address - Country:US
Mailing Address - Phone:512-444-7208
Mailing Address - Fax:512-444-2343
Practice Address - Street 1:4419 FRONTIER TRL STE 110
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1567
Practice Address - Country:US
Practice Address - Phone:512-444-7208
Practice Address - Fax:512-444-2343
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS5147207N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology