Provider Demographics
NPI:1063661924
Name:CENAC, MARK THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:THOMAS
Last Name:CENAC
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11765 N ROBI PL
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-6602
Mailing Address - Country:US
Mailing Address - Phone:520-292-2286
Mailing Address - Fax:520-575-5992
Practice Address - Street 1:11765 N ROBI PL
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-6602
Practice Address - Country:US
Practice Address - Phone:520-292-2286
Practice Address - Fax:520-575-5992
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ17280208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery