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Individual
DR. MARK DONALD KISHBAUGH
Active
Individual
DR. MARK DONALD KISHBAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMSC, PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
43812
MT
363AM0700X
Medical Physician Assistant
1960
AZ
363AM0700X
Medical Physician Assistant
2500
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
68421532
—
CO
Enumeration date
05/03/2006
Last updated
02/09/2026
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