Individual
MR. MARK BURRELL BAZALGETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
165 ROWLAND WAY STE 200, NOVATO, CA 94945-5055
(415) 827-0344
(415) 924-2661
Mailing address
5 BON AIR RD, SUITE 101, LARKSPUR, CA 94939-1143
(415) 924-2515
(415) 924-2661
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
A46290
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A462900
—
CA
Enumeration date
08/31/2006
Last updated
01/22/2020
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