Provider Demographics
NPI:1477576817
Name:SHOWEN, MARK HARRISON (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:HARRISON
Last Name:SHOWEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:50 S SAN MATEO DR
Mailing Address - Street 2:SUITE 180
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3857
Mailing Address - Country:US
Mailing Address - Phone:650-342-4145
Mailing Address - Fax:650-342-2070
Practice Address - Street 1:50 S SAN MATEO DR
Practice Address - Street 2:SUITE 180
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3857
Practice Address - Country:US
Practice Address - Phone:650-342-4145
Practice Address - Fax:650-342-2070
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG052160208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
94-3365742OtherTAX ID