Provider Demographics
NPI:1235220294
Name:STROM, MARK HOWARD (NMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:HOWARD
Last Name:STROM
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Gender:M
Credentials:NMD
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Mailing Address - Street 1:14301 N 87TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3686
Mailing Address - Country:US
Mailing Address - Phone:480-219-2351
Mailing Address - Fax:480-314-0628
Practice Address - Street 1:14301 N 87TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3686
Practice Address - Country:US
Practice Address - Phone:480-219-2351
Practice Address - Fax:480-314-0628
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2008-09-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ08-1048208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice