Healthcare Provider Details

I. General information

NPI: 1235129057
Provider Name (Legal Business Name): MARK DAVID PILLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 11/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11043 PRAIRIE BROOK RD
OMAHA NE
68144-4829
US

IV. Provider business mailing address

PO BOX 871897
VANCOUVER WA
98687-1897
US

V. Phone/Fax

Practice location:
  • Phone: 402-689-6811
  • Fax: 360-844-6336
Mailing address:
  • Phone: 402-689-6811
  • Fax: 360-844-6336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15805
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: