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General NPI Number Information
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NPI Number | 1609051572
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Entity Type | Organization
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Legal Business Name | MARK R NORTHFIELD, M.D.
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Dates
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Enumeration Date | 01/09/2008
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Last Update Date | 01/09/2008
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Provider Practice Location Address
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Address Line | 1496 PROFESSIONAL DR SUITE 601
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City | PETALUMA
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State | CA
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Zip | 94954-6698
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Country | US
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Telephone | 707-778-1131
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Fax | 707-778-3818
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Provider Business Mailing Address
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Address Line | 1496 PROFESSIONAL DR SUITE 601
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City | PETALUMA
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State | CA
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Zip | 94954-6698
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Country | US
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Telephone | 707-778-1131
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Fax | 707-778-3818
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Authorized Official
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Title or Position | RECEPTIONIST
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Name | MRS. LEE D BRILL
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Credential |
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Telephone | 707-778-1131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G77114
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License Number State | CA
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