Doctor Name: | MR. MARK SERRA |
NPI Number: | 1225229347 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DO |
License Number: | L1169747 |
Business Practice Address: | 350 Louisiana Avenue Libby, MT - 59923 |
Business Phone Number: | 4062837000 |
Business Fax Number: | 4062937931 |
Mailing Address: | 350 Louisiana Avenue, LIBBY |
State: | MT |
Postal Code: | 59923 |
Phone Number: | 4062837000 |
Fax Number: | 4062937931 |
NPI Enumeration Date: | 08/05/2007 |
NPI Last Update Date: | 10/09/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | L1169747 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MI |
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. |