Provider Demographics
NPI:1093751323
Name:BIXBY, MARK ROLLINS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ROLLINS
Last Name:BIXBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8301 GOLDEN VALLEY ROAD, SUITE 300
Mailing Address - Street 2:NORTH MEMORIAL HEALTH CARE - CLINIC SERVICES
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4484
Mailing Address - Country:US
Mailing Address - Phone:763-581-0908
Mailing Address - Fax:952-767-2380
Practice Address - Street 1:2600 39TH AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55421-4379
Practice Address - Country:US
Practice Address - Phone:612-706-2900
Practice Address - Fax:612-706-2901
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24754207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNOD081BIOtherBCBS
MN1000070OtherPREFERRED ONE
MN01-22161OtherMEDICA CHOICE & PRIMARY
MN102681OtherUCARE
MN21797OtherARAZ
MN524377700Medicaid
MNHP27055OtherHEALTHPARTNERS
MNHP27055OtherHEALTHPARTNERS
MNOD081BIOtherBCBS