Provider Demographics
NPI:1548258734
Name:WESTBROOK, MARK DENTON (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:DENTON
Last Name:WESTBROOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21309 FOSTER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-4209
Mailing Address - Country:US
Mailing Address - Phone:281-587-1700
Mailing Address - Fax:281-907-6003
Practice Address - Street 1:21309 FOSTER RD STE 100
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-4209
Practice Address - Country:US
Practice Address - Phone:281-587-1700
Practice Address - Fax:281-907-6003
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG3902207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
87426ZOtherHMO BLUE
TXBJ1380OtherBCBS
P00031987OtherMCARE RR
C23362Medicare UPIN
TXBJ1380OtherBCBS