Basic Information
| Provider Information | |||||||||
| NPI: | 1750537205 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOOSTE | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | WOMACK FAMILY MEDICINE RESIDENCY | ||||||||
| Address2: | 2817 REILLY ROAD | ||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283100001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109078500 | ||||||||
| FaxNumber: | 9109078630 | ||||||||
| Practice Location | |||||||||
| Address1: | WOMACK FAMILY MEDICINE RESIDENCY | ||||||||
| Address2: | 2817 REILLY ROAD | ||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283100001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109078500 | ||||||||
| FaxNumber: | 9109078630 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2008 | ||||||||
| LastUpdateDate: | 07/01/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 2015-00358 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.