Healthcare Provider Details

I. General information

NPI: 1962524538
Provider Name (Legal Business Name): MARK D ALLISON MD A PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 CENTRAL AVE #106
RIVERSIDE CA
92506-2933
US

IV. Provider business mailing address

PO BOX 1413
RIVERSIDE CA
92502-1413
US

V. Phone/Fax

Practice location:
  • Phone: 951-788-8332
  • Fax: 951-788-6380
Mailing address:
  • Phone: 951-788-8332
  • Fax: 951-788-6380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC50568
License Number StateCA

VIII. Authorized Official

Name: DR. MARK DAVID ALLISON
Title or Position: PRESIDENT
Credential: MD
Phone: 951-788-8332