Provider Demographics
NPI:1164471223
Name:ALLISON, MARK DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:ALLISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4100 CENTRAL AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2933
Mailing Address - Country:US
Mailing Address - Phone:951-788-8332
Mailing Address - Fax:951-788-6380
Practice Address - Street 1:4100 CENTRAL AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2933
Practice Address - Country:US
Practice Address - Phone:951-788-8332
Practice Address - Fax:951-788-6380
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50568207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD50981Medicare UPIN
CA00C505681Medicare ID - Type Unspecified