| Doctor Name: | DR. MARK C. VITAL |
| NPI Number: | 1073515912 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | K5422 |
| Business Practice Address: | 2855 Gramercy St Houston, TX - 770251635 |
| Business Phone Number: | 7136686828 |
| Business Fax Number: | 7133951666 |
| Mailing Address: | 7155 Old Katy Rd, Suite N100 HOUSTON |
| State: | TX |
| Postal Code: | 770242134 |
| Phone Number: | 7136686828 |
| Fax Number: | 8322803636 |
| NPI Enumeration Date: | 08/11/2005 |
| NPI Last Update Date: | 09/02/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | K5422 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |