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General NPI Number Information
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NPI Number | 1538342001
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Entity Type | Organization
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Legal Business Name | MARK M. SEGALL, MD, A MEDICAL CORPORATION
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Dates
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Enumeration Date | 12/07/2007
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Last Update Date | 12/11/2010
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Provider Practice Location Address
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Address Line | 15195 NATIONAL AVE SUITE 202
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City | LOS GATOS
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State | CA
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Zip | 95032-2631
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Country | US
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Telephone | 408-358-3500
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Fax | 408-358-3608
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Provider Business Mailing Address
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Address Line | 15195 NATIONAL AVE SUITE 202
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City | LOS GATOS
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State | CA
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Zip | 95032-2631
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Country | US
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Telephone | 408-358-3500
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Fax | 408-358-3608
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK M SEGALL
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Credential | M.D.
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Telephone | 408-358-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | GO24951
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License Number State | CA
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