Provider Demographics
NPI:1689602773
Name:EWENS, MARK P (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:P
Last Name:EWENS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2330 W COVELL BLVD
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-5658
Mailing Address - Country:US
Mailing Address - Phone:530-756-2364
Mailing Address - Fax:
Practice Address - Street 1:2330 W. COVELL BLVD
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-5058
Practice Address - Country:US
Practice Address - Phone:530-406-2842
Practice Address - Fax:530-756-5817
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2013-10-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA71440207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A714400OtherBLUE SHIELD
CA080194071OtherRR MEDICARE
CA080194071OtherRR MEDICARE