Provider Demographics
NPI:1659454106
Name:FLOWER, MARK ALLEN (LAC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:FLOWER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1549 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-3507
Mailing Address - Country:US
Mailing Address - Phone:707-546-8880
Mailing Address - Fax:
Practice Address - Street 1:1549 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-3507
Practice Address - Country:US
Practice Address - Phone:707-546-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8985171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0089850OtherPROVIDER MEDICAL NUM
CAAC8985OtherACUPUNCTURE LICENSE NUM
CA2688936Medicare UPIN