Provider Demographics
NPI:1568761831
Name:RABE, MARK L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:RABE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2308 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-1643
Mailing Address - Country:US
Mailing Address - Phone:619-546-0420
Mailing Address - Fax:619-615-2346
Practice Address - Street 1:2308 6TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-1643
Practice Address - Country:US
Practice Address - Phone:619-546-0420
Practice Address - Fax:619-615-2346
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2013-01-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG88279208D00000X
HIMD-14796208D00000X
IL036-079008208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice