Healthcare Provider Details

I. General information

NPI: 1588674659
Provider Name (Legal Business Name): MARK FREDERICK STRASSBURG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MARK F. STRASSBURG M.D.

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 CLINIC DR
DOTHAN AL
36303-1980
US

IV. Provider business mailing address

126 CLINIC DR
DOTHAN AL
36303-1980
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-1881
  • Fax: 334-712-1815
Mailing address:
  • Phone: 334-793-1881
  • Fax: 334-712-1815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number26953
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier009934153
Identifier TypeMEDICAID
Identifier StateAL
Identifier Issuer
# 2
Identifier000816800
Identifier TypeMEDICAID
Identifier StateFL
Identifier IssuerFlorida Medicaid Provider ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: