MEDICARE: DR. MARK EDWARD ADLARD M.D.

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	207Q00000X	Family Medicine Physician	G64159	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	330488458	OTHER	CA	TAX ID
2	ZZZ35743Z	OTHER	CA	BLUE SHIELD OF CA
3	G64159	OTHER	CA	MEDICAL LICENSE CA

General Provider Information

NPI Number	:	1346265766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK EDWARD ADLARD M.D.

Provider Business Mailing Address
First Line	:	22342 AVENIDA EMPRESA
Second Line	:	SUITE 195
City	:	RANCHO SANTA MARGARITA
State	:	CA
Zip	:	92688-2140
Country	:	US
Telephone Number	:	949-858-7001
Fax Number	:	949-858-3826

Provider Business Practice Location Address
First Line	:	22342 AVENIDA EMPRESA
Second Line	:	SUITE 195
City	:	RANCHO SANTA MARGARITA
State	:	CA
Zip	:	92688-2140
Country	:	US
Telephone Number	:	949-858-7001
Fax Number	:	949-858-3826

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	10/13/2010

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Directions to “ DR. MARK EDWARD ADLARD M.D.” Practice Location

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