Provider Demographics
NPI:1649228560
Name:MCPHERSON, MARK KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:KENNETH
Last Name:MCPHERSON
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 1:203 E MORNINGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-4166
Mailing Address - Country:US
Mailing Address - Phone:703-725-8998
Mailing Address - Fax:
Practice Address - Street 1:5700 NOVOSELL
Practice Address - Street 2:USAAMA RM220
Practice Address - City:FORT RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36330-5901
Practice Address - Country:US
Practice Address - Phone:334-255-0750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043091207Q00000X, 2083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine