| Doctor Name: | MR. MARK DONALD KISHBAUGH |
| NPI Number: | 1467410803 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | 1960 |
| Business Practice Address: | 0310 County Road 14 Del Norte, CO - 811328719 |
| Business Phone Number: | 7196572510 |
| Business Fax Number: | 7196574106 |
| Mailing Address: | 0310 County Road 14, DEL NORTE |
| State: | CO |
| Postal Code: | 811322290 |
| Phone Number: | 7196572510 |
| Fax Number: | 7196572511 |
| NPI Enumeration Date: | 05/03/2006 |
| NPI Last Update Date: | 05/10/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 1960 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AZ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |