Provider Demographics
NPI:1043383540
Name:PESCHE, MARK ALAN (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:PESCHE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2525
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93581-2525
Mailing Address - Country:US
Mailing Address - Phone:661-822-2530
Mailing Address - Fax:661-822-2536
Practice Address - Street 1:1001 W TEHACHAPI BLVD
Practice Address - Street 2:SUITE A-100
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-2532
Practice Address - Country:US
Practice Address - Phone:661-822-2530
Practice Address - Fax:661-822-2536
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5732207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD16143Medicare UPIN
CAZZZ24224ZMedicare ID - Type UnspecifiedGROUP NUMBER
CA020A57320Medicare ID - Type Unspecified