Provider Demographics
NPI:1356343412
Name:QUIRING, MARK EDMOND (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:EDMOND
Last Name:QUIRING
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 1:305 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2327
Mailing Address - Country:US
Mailing Address - Phone:903-572-2222
Mailing Address - Fax:903-577-0954
Practice Address - Street 1:305 W 20TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2327
Practice Address - Country:US
Practice Address - Phone:903-572-2222
Practice Address - Fax:903-577-0954
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2013-02-20
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
TXJ2263207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092208001Medicaid
TX8CJ005OtherBLUE CROSS BLUE SHIELD