MEDICARE: DAVID C MABRIE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YS0123X	Facial Plastic Surgery Physician	A71717	CA

General Provider Information

NPI Number	:	1093758138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID C MABRIE MD

Provider Business Mailing Address
First Line	:	2160 APPIAN WAY
Second Line	:	SUITE 202
City	:	PINOLE
State	:	CA
Zip	:	94564-2524
Country	:	US
Telephone Number	:	510-724-6662
Fax Number	:

Provider Business Practice Location Address
First Line	:	2160 APPIAN WAY
Second Line	:	SUITE 202
City	:	PINOLE
State	:	CA
Zip	:	94564-2524
Country	:	US
Telephone Number	:	510-724-6662
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	07/08/2007

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