Provider Demographics
NPI:1356443964
Name:DEUBER, MARK (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:DEUBER
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 1:2801 LEMMON AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2356
Mailing Address - Country:US
Mailing Address - Phone:214-220-2712
Mailing Address - Fax:214-969-0933
Practice Address - Street 1:2801 LEMMON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-2356
Practice Address - Country:US
Practice Address - Phone:214-220-2712
Practice Address - Fax:214-969-0933
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7719174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00547QMedicare ID - Type Unspecified
TXH45704Medicare UPIN