Healthcare Provider Details

I. General information

NPI: 1326102260
Provider Name (Legal Business Name): MARK A. ANTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 HOSPITAL RD SUITE 427
NEWPORT BEACH CA
92663-3522
US

IV. Provider business mailing address

361 HOSPITAL RD SUITE 427
NEWPORT BEACH CA
92663-3522
US

V. Phone/Fax

Practice location:
  • Phone: 949-722-1967
  • Fax: 949-642-5271
Mailing address:
  • Phone: 949-722-1967
  • Fax: 949-642-5271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberG65132
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: