Provider Demographics
NPI:1497931893
Name:POIRIER, MARK DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:POIRIER
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1434 OAKMONT DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-3757
Mailing Address - Country:US
Mailing Address - Phone:719-715-3801
Mailing Address - Fax:
Practice Address - Street 1:1650 COCHRANE CIR UNIT MEDDAC
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4604
Practice Address - Country:US
Practice Address - Phone:719-524-7505
Practice Address - Fax:719-526-4903
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA60425207RN0300X
IDO-1172207RN0300X
ORDO188924207RN0300X
TXQ6684207RN0300X
CODR.0060912207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX372000501Medicaid
TX372000502OtherCSHCN