Provider Demographics
NPI:1144398355
Name:KIFFER, MARK EVERETT (DO, MBA)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EVERETT
Last Name:KIFFER
Suffix:
Gender:M
Credentials:DO, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 W INDIAN PONY CT
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-1542
Mailing Address - Country:US
Mailing Address - Phone:602-319-5919
Mailing Address - Fax:
Practice Address - Street 1:6200 W INDIAN PONY CT
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1542
Practice Address - Country:US
Practice Address - Phone:602-319-5919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3802207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine