Individual
DR. MARK SOUTHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
900 W CLAIRMONT AVE, EAU CLAIRE, WI 54701
(715) 839-4151
Mailing address
2715 WEST FRANK ST, EAU CLAIRE, WI 54703
(715) 834-5511
(715) 834-5870
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
45008
WI
2085R0202X
Diagnostic Radiology Physician
Primary
45008
WI
2085U0001X
Diagnostic Ultrasound Physician
45008
WI
Other
Enumeration date
05/17/2006
Last updated
01/05/2022
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