Healthcare Provider Details

I. General information

NPI: 1669461208
Provider Name (Legal Business Name): MARK M HUTH MD, FACC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 MEDICAL CENTER DR STE 200
MEDFORD OR
97504-4314
US

IV. Provider business mailing address

520 MEDICAL CENTER DR STE 200
MEDFORD OR
97504-4314
US

V. Phone/Fax

Practice location:
  • Phone: 541-282-6606
  • Fax: 541-282-6601
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number18706
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: