Provider Demographics
NPI:1568445211
Name:GARSKOF, MARK MITCHELL (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:MITCHELL
Last Name:GARSKOF
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2963 W WHITE MOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85929-6257
Mailing Address - Country:US
Mailing Address - Phone:928-368-0765
Mailing Address - Fax:928-368-4540
Practice Address - Street 1:2963 W WHITE MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929-6257
Practice Address - Country:US
Practice Address - Phone:928-368-0765
Practice Address - Fax:928-368-4540
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2015-03-17
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Provider Licenses
StateLicense IDTaxonomies
AZ10885207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0389120OtherBCBS
AZ200262Medicaid
AZ200262Medicaid