Provider Demographics
NPI:1174592349
Name:TRASK, DAVID MARK (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARK
Last Name:TRASK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:492 MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8144
Mailing Address - Country:US
Mailing Address - Phone:541-772-0557
Mailing Address - Fax:541-772-1513
Practice Address - Street 1:492 MURPHY RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8144
Practice Address - Country:US
Practice Address - Phone:541-772-0557
Practice Address - Fax:541-772-1513
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14062207N00000X
OR14062207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR026575Medicaid
ORE76832Medicare UPIN
OR026575Medicaid