Healthcare Provider Details

I. General information

NPI: 1154657286
Provider Name (Legal Business Name): RONALD A MARKMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2009
Last Update Date: 04/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7891 LA TIJERA BLVD
LOS ANGELES CA
90045-3145
US

IV. Provider business mailing address

PO BOX 1272
BEVERLY HILLS CA
90213-1272
US

V. Phone/Fax

Practice location:
  • Phone: 310-276-1482
  • Fax: 310-278-2187
Mailing address:
  • Phone: 310-276-1482
  • Fax: 310-278-2187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA19667
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: