Provider Demographics
NPI:1174730816
Name:BADER, MARKUS A (PA)
Entity type:Individual
Prefix:MR
First Name:MARKUS
Middle Name:A
Last Name:BADER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3142 HORIZON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-7815
Mailing Address - Country:US
Mailing Address - Phone:972-772-9600
Mailing Address - Fax:972-772-9601
Practice Address - Street 1:3142 HORIZON RD STE 100
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-7815
Practice Address - Country:US
Practice Address - Phone:972-772-9600
Practice Address - Fax:972-772-9601
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM99-PA26363A00000X
TXPA09849363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX551061ZSTUMedicare PIN
TX551061ZSTTMedicare PIN
TX551061ZSTXMedicare PIN