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Individual

DR. MARK DOUBLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
205 N EAST AVE, JACKSON, MI 49201-1753
(517) 788-4963
(517) 789-5903
Mailing address
205 N EAST AVE, JACKSON, MI 49201-1753
(517) 788-4963
(517) 789-5903

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
51-01-011675
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
4586940
MI
Enumeration date
07/05/2006
Last updated
07/08/2007
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