# MARK TODD ROBACK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1801969829
- **Gender:** Man
- **Credential:** DO

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | R1153 | KY | — |
| 208D00000X | General Practice Physician | 20A10324 | CA | Yes |

## Other

- **Enumeration date:** 11/16/2006
- **Last updated:** 08/25/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1801969829 | NPI | CA |
| 05 | — | 7100028230 | — | KY |
| 01 | — | R1153 | TEMP LICENSE | KY |