Individual
DR. MARK EDWARD GONSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1345 NW WALL ST, SUITE 302, BEND, OR 97703-1970
(541) 323-3960
(541) 323-3961
Mailing address
1345 NW WALL ST, SUITE 302, BEND, OR 97703-1970
(541) 323-3960
(541) 323-3961
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO155003
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12271587
CAQH ID
OR
05
—
500641003
—
OR
Enumeration date
04/16/2008
Last updated
01/10/2024
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