Basic Information
Provider Information | |||||||||
NPI: | 1255327383 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MCCURDY | ||||||||
FirstName: | MARK | ||||||||
MiddleName: | ALAN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 811 W INTERSTATE 20 STE 114 | ||||||||
Address2: |   | ||||||||
City: | ARLINGTON | ||||||||
State: | TX | ||||||||
PostalCode: | 760175871 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8177848268 | ||||||||
FaxNumber: | 8178048178 | ||||||||
Practice Location | |||||||||
Address1: | 811 W INTERSTATE 20 STE 114 | ||||||||
Address2: |   | ||||||||
City: | ARLINGTON | ||||||||
State: | TX | ||||||||
PostalCode: | 76017 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8177848268 | ||||||||
FaxNumber: | 8178048178 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/23/2005 | ||||||||
LastUpdateDate: | 11/26/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | K0345 | TX | Y |   | Allopathic & Osteopathic Physicians | Urology |   |
ID Information
ID | Type | State | Issuer | Description | 136576907 | 05 | TX |   | MEDICAID | 136576908 | 05 | TX |   | MEDICAID | 136576910 | 05 | TX |   | MEDICAID | 136576912 | 05 | TX |   | MEDICAID | 136576909 | 05 | TX |   | MEDICAID |