Doctor Name: | DR. MARK ALBERT BREEDEN |
NPI Number: | 1063747145 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | OD |
License Number: | |
Business Practice Address: | 11500 Hannon Rd Eagle Point, OR - 975249598 |
Business Phone Number: | 5418493168 |
Business Fax Number: | |
Mailing Address: | 1801 Poplar Dr Apt 44, MEDFORD |
State: | OR |
Postal Code: | 975044675 |
Phone Number: | 5418403168 |
Fax Number: | |
NPI Enumeration Date: | 10/07/2009 |
NPI Last Update Date: | 08/31/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |