Provider Demographics
NPI:1306809371
Name:GARBUTT, MARK VERNON (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:VERNON
Last Name:GARBUTT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67905-0245
Mailing Address - Country:US
Mailing Address - Phone:620-624-7900
Mailing Address - Fax:620-624-7979
Practice Address - Street 1:11 W PARKWAY BLVD
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2081
Practice Address - Country:US
Practice Address - Phone:620-624-7900
Practice Address - Fax:620-624-7979
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS04-29195207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSF28573Medicare UPIN