Healthcare Provider Details

I. General information

NPI: 1720015902
Provider Name (Legal Business Name): MARK SCHEER MCGOWAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 15TH ST 1501
SANTA MONICA CA
90404-1135
US

IV. Provider business mailing address

5767 W CENTURY BLVD SUITE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-656-1700
  • Fax: 310-458-1061
Mailing address:
  • Phone: 310-656-1702
  • Fax: 310-458-1061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberG39850
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG39850
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: