Basic Information
| Provider Information | |||||||||
| NPI: | 1356552509 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEDOUX | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17051 DALLAS PKWY STE 300 | ||||||||
| Address2: | |||||||||
| City: | ADDISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750017105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2148883900 | ||||||||
| FaxNumber: | 2148883901 | ||||||||
| Practice Location | |||||||||
| Address1: | 17051 DALLAS PKWY STE 300 | ||||||||
| Address2: | |||||||||
| City: | ADDISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750017105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2148883900 | ||||||||
| FaxNumber: | 2148883901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2007 | ||||||||
| LastUpdateDate: | 06/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | M8781 | TX | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | M8781 | TX | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | M8781 | 01 | TX | TMB | OTHER |