Individual
MARK TODD ROBACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3304 RENNER DR, FORTUNA, CA 95540-7102
(707) 725-4477
(707) 725-9209
Mailing address
670 9TH STREET, SUITE 203, ARCATA, CA 95521-6249
(707) 826-8633
(707) 826-8638
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
R1153
KY
208D00000X
General Practice Physician
Primary
20A10324
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1801969829
NPI
CA
05
—
7100028230
—
KY
01
—
R1153
TEMP LICENSE
KY
Enumeration date
11/16/2006
Last updated
08/25/2014
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