Provider Demographics
NPI:1700923877
Name:HOWARD, MARK A K (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A K
Last Name:HOWARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2402 W PIERCE ST
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3566
Mailing Address - Country:US
Mailing Address - Phone:575-885-1970
Mailing Address - Fax:575-885-6383
Practice Address - Street 1:2402 W PIERCE ST
Practice Address - Street 2:SUITE 6A
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3566
Practice Address - Country:US
Practice Address - Phone:575-885-1970
Practice Address - Fax:575-885-6383
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM82-68207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00006957Medicaid
NM00NM001278OtherBLUE CROSS BLUE SHIELD
2132507Medicare PIN
NM00NM001278OtherBLUE CROSS BLUE SHIELD