Provider Demographics
NPI:1376508861
Name:EAST, MARK DAVID (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:DAVID
Last Name:EAST
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1613 N MCKENZIE ST
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-2247
Mailing Address - Country:US
Mailing Address - Phone:251-949-3710
Mailing Address - Fax:251-949-3715
Practice Address - Street 1:1613 N MCKENZIE ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2247
Practice Address - Country:US
Practice Address - Phone:251-949-3710
Practice Address - Fax:251-949-3715
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALDO.1318207RC0200X, 207RP1001X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL148106Medicaid
MS5279713Medicaid
KY7100684480Medicaid
MO501522809Medicaid
MO242766624Medicaid