Provider Demographics
NPI:1699833020
Name:WARFORD, MARK ALLEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLEN
Last Name:WARFORD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4136 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-7413
Mailing Address - Country:US
Mailing Address - Phone:916-548-0218
Mailing Address - Fax:916-965-4129
Practice Address - Street 1:4136 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7413
Practice Address - Country:US
Practice Address - Phone:916-548-0218
Practice Address - Fax:916-965-4129
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3548213E00000X, 213EP1101X, 213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E35480Medicare ID - Type Unspecified
CAT92863Medicare UPIN
CABW793AMedicare PIN