Individual
MARK CARLTON ROUNSAVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
45 LOS PINOS, NICASIO, CA 94946
(415) 662-2669
(415) 662-2669
Mailing address
45 LOS PINOS, NICASIO, CA 94946
(415) 662-2669
(415) 662-2669
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
A39060
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A390600
BLUE SHIELD
CA
05
—
00A390600
—
CA
Enumeration date
11/04/2005
Last updated
05/17/2022
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