Provider Demographics
NPI:1346241452
Name:TAMSEN, MARK J (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:TAMSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:PO BOX 370630
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92137-0630
Mailing Address - Country:US
Mailing Address - Phone:619-225-6200
Mailing Address - Fax:619-225-6208
Practice Address - Street 1:3434 MIDWAY DR STE 1002
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4924
Practice Address - Country:US
Practice Address - Phone:619-225-6200
Practice Address - Fax:619-225-6208
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2020-12-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG64400207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G644000Medicaid
CA00G644000Medicaid