Provider Demographics
NPI:1841404613
Name:VAN ESS, MARK JOHN (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JOHN
Last Name:VAN ESS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1229 E SEMINOLE ST STE 520
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2227
Mailing Address - Country:US
Mailing Address - Phone:417-820-5750
Mailing Address - Fax:417-820-5066
Practice Address - Street 1:1229 E SEMINOLE ST STE 520
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2227
Practice Address - Country:US
Practice Address - Phone:417-820-5750
Practice Address - Fax:417-820-5066
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2011-08-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2009014117207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1841404613Medicaid
MO1841404613Medicaid