Organization
JEFFERY A MARK PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF MARK (OWNER)
(574) 295-4141
Entity
Organization
Contact information
Practice address
515 S 2ND ST, ELKHART, IN 46516-3224
(574) 295-4141
Mailing address
515 S 2ND STREET, ELKHART, IN 46516
(574) 295-4141
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01039223A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100114070B
—
IN
Enumeration date
11/29/2011
Last updated
11/29/2011
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