Provider Demographics
NPI:1912900218
Name:MARK, DAVID BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRUCE
Last Name:MARK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1010 W FREMONT AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-3019
Mailing Address - Country:US
Mailing Address - Phone:408-739-6200
Mailing Address - Fax:408-739-2439
Practice Address - Street 1:1010 W FREMONT AVE
Practice Address - Street 2:STE 200
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-3019
Practice Address - Country:US
Practice Address - Phone:408-739-6200
Practice Address - Fax:408-739-2439
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2013-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG35305207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9533828Medicaid
CA00G35305Medicare PIN
CAA46302Medicare UPIN