Provider Demographics
NPI:1679680839
Name:PISKUN, MARY ANN (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:PISKUN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:500 QUAIL CREEK DR
Mailing Address - Street 2:UNIT B
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-1637
Mailing Address - Country:US
Mailing Address - Phone:806-358-8731
Mailing Address - Fax:806-358-8837
Practice Address - Street 1:1801 HALSTEAD ST
Practice Address - Street 2:SUITE B
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1830
Practice Address - Country:US
Practice Address - Phone:806-358-8731
Practice Address - Fax:806-358-8837
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2018-07-20
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Provider Licenses
StateLicense IDTaxonomies
TXK0156208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0090EJOtherBCBS
TX121567100OtherFIRSTCARE/SWLH
TX240006650OtherRAILROAD MEDICARE
TX096447001Medicaid
TX096447001Medicaid
TX0090EJOtherBCBS