Provider Demographics
NPI:1073517769
Name:GACEK, MARK RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:RICHARD
Last Name:GACEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4721 MORRISON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-3350
Mailing Address - Country:US
Mailing Address - Phone:251-340-6947
Mailing Address - Fax:251-340-7971
Practice Address - Street 1:720 HILLCREST RD STE A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-3904
Practice Address - Country:US
Practice Address - Phone:251-340-7970
Practice Address - Fax:866-873-8411
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2022-08-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL0002107207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51134625OtherBC AL
AL148969Medicaid
AL102I049653Medicare PIN
AL51134625OtherBC AL