Healthcare Provider Details

I. General information

NPI: 1699753046
Provider Name (Legal Business Name): MARK DRUCKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 SAN MIGUEL DR #28
WALNUT CREEK CA
94596-5214
US

IV. Provider business mailing address

1855 SAN MIGUEL DR #28
WALNUT CREEK CA
94596-5214
US

V. Phone/Fax

Practice location:
  • Phone: 925-935-4978
  • Fax: 925-935-9542
Mailing address:
  • Phone: 925-935-4978
  • Fax: 925-935-9542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG0045173
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: