Active NPI
Mark W. Izzard, PSY. D.
- Clinical Psychologist
- Amarillo, TX
National Provider Identifier
1376550947
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 30789
- Practice address
- 1208 Wolflin Ave
Amarillo, TX 79109-2252 - Phone
- (806) 468-7980
- Fax
- (806) 468-7987
- NPI assigned
- Aug 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 30789 | TX | Primary |
Addresses
Primary practice location
1208 Wolflin Ave
Amarillo, TX 79109-2252
Mailing address
1208 Wolflin Ave
Amarillo, TX 79109-2252
Phone (806) 468-7980
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0012GD | Other | TX | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30789 | TX | MD | Prosthodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376550947",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1208 WOLFLIN AVE",
"city": "AMARILLO",
"state": "TX",
"postal_code": "791092252",
"telephone_number": "806-468-7980",
"fax_number": "806-468-7987"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1208 WOLFLIN AVE",
"city": "AMARILLO",
"state": "TX",
"postal_code": "791092252",
"telephone_number": "806-468-7980",
"fax_number": "806-468-7987"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IZZARD",
"first_name": "MARK",
"middle_name": "W.",
"name_prefix": "Dr.",
"credential": "PSY. D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TX",
"license": "30789",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "0012GD",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Amarillo, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.