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General NPI Number Information
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NPI Number | 1609192715
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Entity Type | Individual
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Provider Name | MARK DAVID PEASE M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/14/2010
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Last Update Date | 09/15/2020
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Provider Practice Location Address
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Address Line | 2074 S MCKENZIE ST STE 233
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City | FOLEY
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State | AL
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Zip | 36535-1751
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Country | US
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Telephone | 985-373-2535
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Fax | 877-476-7801
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Provider Business Mailing Address
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Address Line | 2497 TREE HOUSE DR
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City | WOODBRIDGE
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State | VA
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Zip | 22192-1316
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Country | US
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Telephone | 985-373-2535
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Fax | 877-476-7801
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 276897
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | MD.33779
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License Number State | AL
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