Provider Demographics
NPI:1992714885
Name:YARSHEN, MARK J (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:YARSHEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:JAMES
Other - Last Name:YARSHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:4421 STATE HIGHWAY 6 S STE 100
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-6176
Mailing Address - Country:US
Mailing Address - Phone:979-690-4460
Mailing Address - Fax:979-690-4461
Practice Address - Street 1:4421 STATE HIGHWAY 6 S STE 100
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-6176
Practice Address - Country:US
Practice Address - Phone:979-690-4460
Practice Address - Fax:979-690-4461
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114086207Q00000X
TXS8406207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036114086 2Medicaid
IL2221474OtherBCBS
TX418887201Medicaid
TX8NL795OtherBCBS PROVIDER ID