Healthcare Provider Details

I. General information

NPI: 1477576817
Provider Name (Legal Business Name): MARK HARRISON SHOWEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 S SAN MATEO DR SUITE 180
SAN MATEO CA
94401-3857
US

IV. Provider business mailing address

50 S SAN MATEO DR SUITE 180
SAN MATEO CA
94401-3857
US

V. Phone/Fax

Practice location:
  • Phone: 650-342-4145
  • Fax: 650-342-2070
Mailing address:
  • Phone: 650-342-4145
  • Fax: 650-342-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG052160
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: