Provider Demographics
NPI:1942250089
Name:SCHEURER, MARK MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:MATTHEW
Last Name:SCHEURER
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 1:1222 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-1491
Mailing Address - Country:US
Mailing Address - Phone:619-787-7406
Mailing Address - Fax:619-359-8762
Practice Address - Street 1:1222 1ST ST STE 3
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1491
Practice Address - Country:US
Practice Address - Phone:619-787-7406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15237207Y00000X
CAA106775207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
223361OtherMEDICARE PTAN