Provider Demographics
NPI:1396770335
Name:MARES, DAVID C (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:MARES
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 1:2101 JACKSON ST STE 110
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-4386
Mailing Address - Country:US
Mailing Address - Phone:765-643-6012
Mailing Address - Fax:765-646-9054
Practice Address - Street 1:2101 JACKSON ST
Practice Address - Street 2:#110
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016
Practice Address - Country:US
Practice Address - Phone:765-643-6012
Practice Address - Fax:765-646-9054
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041834207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100097760BMedicaid
000000085467OtherBLUE SHIELD
110168017OtherRAILROAD MEDICARE
000000085467OtherBLUE SHIELD
505540BMedicare ID - Type Unspecified