1912900218 NPI number — DR. DAVID BRUCE MARK M.D.

Table of content: DR. DAVID BRUCE MARK M.D. (NPI 1912900218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912900218 NPI number — DR. DAVID BRUCE MARK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARK
Provider First Name:
DAVID
Provider Middle Name:
BRUCE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912900218
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1010 W FREMONT AVE
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
SUNNYVALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94087-3019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-739-6200
Provider Business Mailing Address Fax Number:
408-739-2439

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 W FREMONT AVE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
SUNNYVALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94087-3019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-739-6200
Provider Business Practice Location Address Fax Number:
408-739-2439
Provider Enumeration Date:
05/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  G35305 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9533828 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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