Healthcare Provider Details

I. General information

NPI: 1376521740
Provider Name (Legal Business Name): MARK DAVID ZUBRES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ALTURA VISTA
SANTA FE NM
87507-7771
US

IV. Provider business mailing address

1 ALTURA VISTA
SANTA FE NM
87507-7771
US

V. Phone/Fax

Practice location:
  • Phone: 417-766-7522
  • Fax:
Mailing address:
  • Phone: 417-766-7522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberR8N04
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number163134
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: