Provider Demographics
NPI:1730180290
Name:MARES, ADOLPH JR (MD)
Entity type:Individual
Prefix:
First Name:ADOLPH
Middle Name:
Last Name:MARES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 402669
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-2669
Mailing Address - Country:US
Mailing Address - Phone:512-206-4300
Mailing Address - Fax:512-206-4350
Practice Address - Street 1:800 W CENTRAL TEXAS EXPY
Practice Address - Street 2:STE. 355
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-1899
Practice Address - Country:US
Practice Address - Phone:254-526-2085
Practice Address - Fax:254-526-9569
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2022-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXH7323207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1358335-10Medicaid
TX1358335-01Medicaid
TX8827M1Medicare PIN
TX8634J4Medicare PIN