Provider Demographics
NPI:1871607820
Name:PRANGE, MARK ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:PRANGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5007 E BEVERLY MAE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4939
Mailing Address - Country:US
Mailing Address - Phone:210-417-3341
Mailing Address - Fax:210-568-4942
Practice Address - Street 1:5007 E BEVERLY MAE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4940
Practice Address - Country:US
Practice Address - Phone:210-417-3341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2696207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E07153Medicare UPIN