Provider Demographics
NPI:1164436994
Name:DAY, MARK (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:DAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50698
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-0698
Mailing Address - Country:US
Mailing Address - Phone:702-456-9100
Mailing Address - Fax:702-434-7354
Practice Address - Street 1:56 N PECOS RD
Practice Address - Street 2:STE A
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-0698
Practice Address - Country:US
Practice Address - Phone:702-456-9100
Practice Address - Fax:702-434-7354
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV656207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV31556Medicare ID - Type Unspecified
F43882Medicare UPIN