Provider Demographics
NPI:1134145501
Name:PERL, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:PERL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 MONTGOMERY ST
Mailing Address - Street 2:SUITE 830
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-2902
Mailing Address - Country:US
Mailing Address - Phone:415-550-7535
Mailing Address - Fax:415-550-7535
Practice Address - Street 1:235 MONTGOMERY ST
Practice Address - Street 2:SUITE 830
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-2902
Practice Address - Country:US
Practice Address - Phone:415-550-7535
Practice Address - Fax:415-550-7535
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA373012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A373010Medicare ID - Type Unspecified
CAA28350Medicare UPIN