Provider Demographics
NPI:1578629317
Name:SYLVESTER, MARK TRENT (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:TRENT
Last Name:SYLVESTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9236
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95604-9236
Mailing Address - Country:US
Mailing Address - Phone:916-764-0733
Mailing Address - Fax:530-887-0348
Practice Address - Street 1:12719 SHOCKLEY WOODS COURT
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603
Practice Address - Country:US
Practice Address - Phone:916-764-0733
Practice Address - Fax:530-887-0348
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75212207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G752122Medicaid
CA00G752120Medicare ID - Type Unspecified
CA00G752122Medicaid